Use of fkbp-l polypeptides and nucleic acids for the treatment of obesity

ABSTRACT

The inventors have determined that increasing the expression level or activity of FKBP-L polypeptide in a subject, which can be provided by expression of nucleic acids encoding FKBP-L or by providing FKBP-L polypeptides to a subject is advantageous for use in the treatment of obesity and obesity-related disorders. In particular increased expression or activity of FKBP-L polypeptide in a subject may be used to treat excessive weight gain (which can be characterised as obesity), glucose intolerance, diabetes and metabolic syndrome, which are closely linked to obesity and insulin resistance. FKBP-L can also be used as a biomarker for obesity and obesity-related disorders.

CROSS-REFERENCE TO RELATED APPLICATIONS

This patent application claims priority from U.S. patent applicationSer. No. 16/343,266, having a 371(c) date of Apr. 18, 2013, which is anational stage entry of PCT/GB2017/053157, filed on Oct. 18, 2017.PCT/GB2017/053157 claims priority from GB 1617726.3, filed on Oct. 19,2016, and GB 1617761.0 filed on Oct. 20, 2016. Each of theaforementioned applications are incorporated herein by reference.

FIELD OF THE INVENTION

The present invention relates to the use of FKBP-L polypeptides ornucleic acids encoding FKBP-L for treating obesity and obesity-relateddisorders. In a further aspect, the invention is concerned with the useof FKBP-L polypeptides or nucleic acids encoding FKBP-L as a biomarkerfor obesity and obesity-related disorders.

BACKGROUND OF THE INVENTION

Obesity can be described as a state of excessive accumulation of bodyfat (weight gain), and is widely considered to be a major public healthproblem, being associated with substantially increased morbidity andmortality, as well as psychological problems, reduced economicachievement, and discrimination.

Obesity disrupts many body systems including glucose and lipidmetabolism, circadian rhythms and liver function. It also causes orincreases inflammation and oxidative stress.

Examples of health and social problems thought to be caused orexacerbated by obesity (obesity related disorders) include coronaryheart disease, stroke, obstructive sleep apnea, diabetes mellitus type2, gout, hyperlipidemia, osteoarthritis, reduced fertility, impairedpsychosocial function, reduced physical agility and increased risk ofaccidents, impaired obstetrical performance, reduced economicperformance and discrimination and prejudice. One of the strongest linksis with type 2 diabetes. Increases in body fat alter the body's responseto insulin, potentially leading to insulin resistance. As a result,obesity has been found to reduce life expectancy.

The global economic cost of obesity is estimated to be $2 trillionannually. Causes of obesity remain unclear, however whether obesity isof genetic origin or is promoted by a genotype-environment interaction,or both, it remains true that energy intake must have exceeded metabolicand physical (work) energy expenditure for there to have been surplusenergy available for fat deposition.

Methods for managing body weight by dietary restriction and/or byexercise are largely ineffective as few people stick to dietary regimensfor a long time, and compliance to regular exercise is equally poor.

The result is generally a transient phase of weight loss (or weightstability) followed by a return on the trajectory towards obesity. Thesefailures have highlighted the need for safe anti-obesity therapies.

SUMMARY OF THE INVENTION

The inventors have now unexpectedly found that increasing the expressionlevel or activity of FKBP-L polypeptide in a subject, which can beprovided by expression of nucleic acids encoding FKBP-L or by providingFKBP-L polypeptides to a subject is advantageous for use in thetreatment of obesity and obesity-related disorders. In particularincreased expression or activity of FKBP-L polypeptide in a subject maybe used to treat excessive weight gain (which can be characterised asobesity), glucose intolerance, diabetes and metabolic syndrome, whichare closely linked to obesity and insulin resistance.

More particularly, the inventors have found that isolated FKBP-Lpolypeptides or a biologically active fragment of FKBP-L polypeptide ora biologically active derivative thereof, or a biologically activederivative of a fragment of FKBP-L or a nucleic acid encoding such anFKBP-L polypeptide are useful in the treatment of obesity andobesity-related disorders. Likewise, the inventors consider a deficiencyin the FKBP-L gene causes obesity, and thus the level of FKBP-L orreduced functionality within FKBP-L, as a result of a mutation or singlenucleotide polymorphism can be used as an indicator for obesity risk.

FKBP-L belongs to the family of FK506 binding proteins and it is animportant regulator of angiogenesis, targeting the CD44 pathway(Arteriosclerosis Thrombosis and Vascular Biology April; 35(4):845-54).FKBP-L is a divergent member of this protein family with very differentfunctions from other family members for example FKBP11 and FKBP4.

Without wishing to be bound by theory, it is considered that adiposetissue mass is determined by two mechanisms: hypertrophy (increase insize of adipocytes) and hyperplasia (increase in adipocyte number)(Amaia Rodriguez, Silvia Ezquerro, Leire Mendez-Gimenez, Sara Becerril,Gema Fruhbeck Revisiting the adipocyte: a model for integration ofcytokine signaling in the regulation of energy metabolism, AmericanJournal of Physiology—Endocrinology and Metabolism, 2015 309, 8,E691-E714 DOI:10.1152/ajpendo.00297.2015). Hypertrophy is considered tobe the main contributor to adipose tissue enlargement and is associatedwith abnormal adipocyte function, increased basal fatty acid release,pro-inflammatory cytokine release, immune cell recruitment, hypoxia,fibrosis, decreased adiponectin, and impaired insulin sensitivity.Enhanced angiogenesis does not correlate with hypertrophy. The inventorshave found that FKBP-L-mediates effects on adiposity with Fkbpl^(+/−)mice demonstrating a significant increase in the number and size ofadipocytes.

Thus, inhibition of angiogenesis is not the driver for theFKBP-L-mediated protection against obesity.

Furthermore, WAT from these mice clearly demonstrate hypertrophic tissueexpansion. Deregulation of FKBP-L levels might inhibit adipogenesiswhich is strongly associated with adipocyte hypertrophy as observed inthe FKBP-L deicinet mice (Fkbpl^(+/−)) mice.

Furthermore, an impaired local proinflammatory response in the adipocyteleads to increased ectopic lipid accumulation, glucose intolerance, andsystemic inflammation. Adipocyte hypertrophy and hypoxia provide idealenvironments for the development of adipose tissue inflammation, bypromoting the influx of macrophages and other immune cells. Theinflammation is mediated by producing a large number of cytokines andchemokines which in turn promote further recruitment of pro-inflammatoryimmune cells into the adipose tissue. The inventors have shown thatFKBP-L/ALM201 regulates cytokine networks associated with obesity,reducing secreted leptin, TIMP1 and IL-8 levels.

FKBP-L fragments—for example AD-01 (24 as peptide)—can inhibitlipopolysaccaride induced NFkB signalling in the THP1 monocyte cell lineand this results in a dramatic reduction in the pro-inflammatorycytokine IL-1β secretion. Macrophages within the adipose tissue arepolarized to the M1 inflammatory phenotype, producing thisproinflammatory cytokine. The inventors therefore consider endogenousFKBP-L and its therapeutic peptides may also be protective of obesitythrough abrogation of inflammatory signalling in both adipocytes andmacrophages.

It is further considered that FKBP-L and its peptides can protectagainst TLR-mediated signalling pathway associated with obesity, leadingto reduced NFkB signalling and IL-1β secretion. The mechanism by whichIL-1β is secreted, culminates from the activation of a common receptorcomplex, the NLRP3 inflammasome, triggered by Toll-like receptoractivation. TLR receptors, initially thought to be involved inrecognizing microbial danger signals, may also mediate immune responsesto endogenous danger signals, including those arising in metabolicdysfunction, such as T2D.

It is further considered that FKBP-L can regulate SIRT1 levels. SIRT1 isa protein deacetylase which controls both glucose and lipid metabolismin the liver, promotes fat mobilization and stimulates brown remodelingof the white fat in white adipose tissue, controls insulin secretion inthe pancreas, senses nutrient availability in the hypothalamus,influences obesity-induced inflammation in macrophages, and modulatesthe activity of circadian clock in metabolic tissues (Xiaoling Li, ActaBiochim Biophys Sin (Shanghai) SIRT1 and energy metabolism). 2013January; 45(1): 51-60. doi: 10.1093/abbs/gms108 PMCID: PMC3527007). Theinventors consider that when FKBP-L levels are low, as observed inFKBPL+/− mice, SIRT1 levels fall. This fall in SIRT1 could also help toexplain the weight gain in our mice and the glucose intolerance. FKBPL-1polypeptides (ALM201) can increase SIRT1 levels.

WO 2007141533 discloses the use of FKBP-L polypeptides and prodrugsthereof to modulate angiogenesis and cell migration to treat or preventa disorder associated with angiogenesis specifically includingcarcinomas/tumours, inflammation, ocular disorders or wound healing.

Combinations of FKBP-L polypeptides with existing therapeutic agents foruse in such diseases are also disclosed in WO 2007141533.

WO 2007141533 does not disclose or teach the use of FKBP-L polypeptidesin the treatment of obesity and/or obesity-related disorders.

In obesity, adipose tissue angiogenesis plays a complex role to supporttissue growth and promote metabolic disease. However, whilst someteaching in the art has suggested anti-angiogenic therapy may reduceadiposity, others have shown that reduction of angiogenesis leading toreduced blood vessels can enhance adipose tissue perturbations such ashypoxia, inflammation, and apoptosis, eventually leading to systemicinsulin resistance, worsening obesity (Lemoine AY1, Ledoux S, Larger E.Adipose tissue angiogenesis in obesity. Thromb Haemost. 2013October;110(4):661-8. doi: 10.1160/TH13-01-0073. Epub 2013 Apr. 18. andSung, H. K., Doh, K. O., Son, J. E., Park, J. G., Bae, Y., Choi, S.,Nelson, S. M., Cowling, R., Nagy, K., Michael, I. P. et al. Adiposevascular endothelial growth factor regulates metabolic homeostasisthrough angiogenesis. Cell Metab. 2013; 17: 61-72). In particular,although the inhibition of adipose tissue angiogenesis had originallybeen proposed as a means of treating obesity, this concept hassubsequently been challenged by the paradox that energy expendituremight also require angiogenesis. This is particularly true for thedevelopment of BAT for protection against obesity (Cao, Y.'Angiogenesismodulates adipogenesis and obesity.'J. Clin. Invest.117, 2362-2368(2007) and Xue, Y. et al.'Hypoxia-independent angiogenesis in adiposetissues during cold acclimation.'Cell Metab. 9, 99-109 (2009)).

Obesity and metabolic syndrome is thus a complicated and dynamic processand therapeutic treatments of obesity and metabolic diseases, targetingangiogenesis, remains a disputed issue.

The present invention provides a FKBP-L polypeptide, a biologicallyactive fragment of an FKBP-L polypeptide, a derivative of FKBP-Lpolypeptide, or a derivative of a biologically active fragment of anFKBP-L polypeptide, or a nucleic acid sequence capable of beingexpressed in a subject to provide FKBP-L or a biologically activefragment or derivative thereof for use in the treatment of obesity andobesity-related disorders.

It is considered that the FKBP-L polypeptides/peptides, prodrugs,nucleic acids and combinations discussed in WO20071411533 can beutilised in the present invention to treat obesity and/or obesityrelated disorders.

The present invention also provides methods for treatment of obesity andobesity-related disorders in a human or animal subject or patient byadministration of a FKBP-L polypeptide, a biologically active fragmentof an FKBP-L polypeptide, a derivative of FKBP-L polypeptide, or aderivative of a biologically active fragment of an FKBP-L polypeptide,or a nucleic acid sequence capable of being expressed in a subject toprovide FKBP-L or a biologically active fragment or derivative thereof.

The present invention also provides the use of a FKBP-L polypeptide, abiologically active fragment of an FKBP-L polypeptide, a derivative ofFKBP-L polypeptide, or a derivative of a biologically active fragment ofan FKBP-L polypeptide, or a nucleic acid sequence capable of beingexpressed in a subject to provide FKBP-L or a biologically activefragment or derivative thereof for use in the preparation of amedicament for the treatment of obesity and obesity-related disorders.

Further in accordance with the present invention, there is provided apharmaceutical composition comprising a FKBP-L polypeptide, abiologically active fragment of an FKBP-L polypeptide, a derivative ofFKBP-L polypeptide, or a derivative of a biologically active fragment ofan FKBP-L polypeptide, or a nucleic acid sequence capable of beingexpressed in a subject to provide FKBP-L or a biologically activefragment or derivative thereof and at least one pharmaceutical carrier,wherein a FKBP-L polypeptide, a biologically active fragment or aderivative thereof is present in an amount effective for use in thetreatment of obesity and obesity-related disorders.

In a further aspect of the invention, there is provided a FKBP-Lpolypeptide, a biologically active fragment of an FKBP-L polypeptide, aderivative of FKBP-L polypeptide, or a derivative of a biologicallyactive fragment of an FKBP-L polypeptide thereof, or a nucleic acidsequence capable of being expressed in a subject to provide FKBP-L or abiologically active fragment or derivative thereof in combination withat least one pharmacologically active agent (s) that is (are) useful inthe treatment of obesity or obesity-related disorders.

In a yet further aspect of the invention, there is provided the use of aFKBP-L polypeptide, a biologically active fragment of an FKBP-Lpolypeptide, a derivative of FKBP-L polypeptide, or a derivative of abiologically active fragment of an FKBP-L polypeptide thereof, or anucleic acid sequence encoding FKBP-L as expressed in a subject toprovide FKBP-L or a biologically active fragment or derivative as abiomarker for obesity. By determining endogenous expression or activitylevels of FKBP-L and determining whether these are considered to be in a‘normal range’ or ‘reduced’, where the expression or activity level isreduced it would be indicative of obesity or obesity related disorders.The inventors have determined lower serum FKBP-L in obese compared tonormal individuals and further have correlated FKBP-L with the level ofBMI. According to an aspect of the invention, low levels of FLBP-L couldbe used as a predictive biomarker whereby individuals with obesity orpredisposed to obesity could be treated with FKBP-L polypeptides/nucleicacids. Treatment with FKBP-L may cause an enhanced response in obeseindividuals deficient in FKBP-L In embodiments the expression level oractivity of FKBP-L can be determined as a biomarker for obesity.Suitably, the expression level or activity of FKBP-L may be determinedby determining SNP(s) of FKBP-L, preferably SNP(s) within the FKBP-Lgene of the subject being tested.

An embodiment of the present invention will now be described by way ofexample only with reference to the accompanying figures in which:

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A and 1B show that mice wherein one allele of FKBP-L was knockedout (i.e. Fkbpl^(+/−) mice) are significantly heavier to their wild-type(WT) littermates, Fkbpl^(+/+) on a normal diet between 2-6 months (1B)and in mice approximately 14 months old (1A).

FIG. 1C is a graph of percent weight gain of Fkbpl^(+/−) and Fkbpl^(+/+)mice in a high fat diet (HFD) vs. time (p<0.05; two-way ANOVA) andindicate that Fkbpl^(+/−) mice have a tendency to gain significantlymore weight than Fkbpl^(+/+) mice (p<0.05; two-way ANOVA).

FIG. 1D is a graph of blood glucose concentration in Fkbpl^(+/−) andFkbpl^(+/+) mice wild-type (WT) vs. time after administration of 40%glucose solution (Oral Glucose Tolerance Test (OGTT))—blood glucosereadings were recorded at 0, 30 and 60 min wherein Fkbpl^(+/−) micedemonstrate intolerance to glucose upon stimulation with 40% glucose(Oral Glucose Tolerance Test (OGTT)) compared to Fkbpl^(+/+) wild-type(WT) littermates i.e. Fkbpl^(+/−) had significantly higher blood glucosereadings at 30 and 60 min than Fkbpl^(+/+) mice (WT mice).

FIG. 2A is a bar graph showing increasing of % adipose tissue by % ofbody weight in Fkbpl^(+/−) and Fkbpl^(+/+) mice (>5 months) on a normaldiet—Fkbpl^(+/−) mice had an increase % of subcutaneous body fatcompared to Fkbpl^(+/+) mice of same age (>5 months) (n=3).

FIG. 2B is an image of visceral fat surrounding major organs ofFkbpl^(+/−) and Fkbpl^(+/+) mice—Fkbpl^(+/−) mice have increasedvisceral fat surrounding major organs than Fkbpl^(+/+) littermates.

FIG. 2C is a representative image of the number and size of adipocytesin Fkbpl^(+/−) and Fkbpl^(+/+) mice—Adipoctyes isolated from Fkbpl^(+/−)mice were more numerous and larger in size than those from Fkbpl^(+/+)and they could be stained by Nile-Red (representative images). **p<0.01, * p<0.05.

FIG. 2D is a bar graph showing % increase in adipose stem cells isolatedfrom Fkbpl^(+/−) mice compared to WT littermates (Fkbpl^(+/+) mice). Thedata have been generated using a protocol based on the method developedby Halvorsen et al.

FIG. 3 provides graphs showing the weekly food intake vs the time forFkbpl^(+/−) mice and WT littermates (Fkbpl^(+/+) mice) fed a normal chowdiet or a high fat diet (HFD)—Food intake of male Fkbpl^(+/+) andFkbpl^(+/−) mice was measured daily for two weeks. Mice were fed eitherstandard chow or high fat diet. They were housed individually. Foodintake of Fkbpl^(+/−) mice on a standard chow or high fat diet was notsignificantly different to wild-type (WT) littermates, Fkbpl^(+/+). (A)Daily food intake for Fkbpl^(+/+) (n=4) and Fkbpl^(+/−) (n=4) male micereceiving a standard chow diet. (B) Daily food intake for Fkbpl^(+/+)(n=4) and Fkbpl^(+/−) (n=4) male mice receiving a high fat diet. (C)Average daily food intake for Fkbpl^(+/+) (n=4) and Fkbpl^(+/−) (n=4)male mice receiving a standard chow diet. (D) Average daily food intakefor Fkbpl^(+/+) (n=4) and Fkbpl^(+/−) (n=4) male mice receiving a highfat diet.

FIG. 4A shows the weight gain of Fkbpl^(+/+) wild-type (WT) andFkbpl^(+/−) mice vs time after feeding a high fat diet (HFD)—Fkbpl^(+/−)mice have a tendency to gain significantly more weight than Fkbpl^(+/+)wild-type (WT) mice after feeding a high fat diet (HFD) (p<0.05; two-wayANOVA).

FIG. 4B shows the weight gain of Fkbpl^(+/+) wild-type (WT) mice andFkbpl^(+/−) treated with ALM201 (an FKBP-L nucleic acid sequencecomprising amino acids) vs time after feeding a high fat diet(HFD)—administering ALM201 (0.3 mg/kg to Fkbpl^(+/−) normalizes themouse weight gain to that of Fkbpl^(+/+) so that the difference is nolonger significant.

FIG. 4C shows the weight gain of Fkbpl^(+/−) and Fkbpl^(+/+) treatedwith ALM201 vs time after feeding a high fat diet (HFD)—ALM201 reducesand normalizes weight gain as Fkbpl^(+/−) mice given ALM201 are comparedto Fkbpl^(+/−) mice administered PBS.

FIG. 5A shows the blood glucose concentration in Fkbpl^(+/−) andFkbpl^(+/+) mice wild-type (WT) vs. time after administration of 40%glucose solution (Oral Glucose Tolerance Test (OGTT))—Fkbpl^(+/−) hadsignificantly higher blood glucose readings at 30 and 60 min thanFkbpl^(+/+) mice.

FIGS. 5B and 5C show blood glucose concentration in Fkbpl^(+/−) treatedwith ALM201 and Fkbpl^(+/+) mice wild-type (WT) and Fkbpl^(+/−) treatedwith ALM201 and Fkbpl^(+/−) mice vs. time after administration of 40%glucose solution (Oral Glucose Tolerance Test (OGTT))—(B) There was nosignificant difference observed between the blood glucose levels ofFkbpl^(+/−) and Fkbpl^(+/+) mice administered ALM201 (C) Fkbpl^(+/−)given ALM201 had significantly lower blood glucose readings at 30 and 60min than Fkbpl^(+/−) mice given PBS; ** p<0.01, *** p<0.001.

FIG. 6A illustrates qRT-PCR of FKBP-L and SIRT1 mRNA in tissues fromFkbpl^(+/−) (het) mice and Fkbpl^(+/+) (WT) littermates in kidney andlung tissues.

FIG. 6B shows western blots demonstrating increased SIRT1 in FKBP-L overexpressing stable cell lines (A3 and D2) compared to parental lines (MDAand MCF-7).

FIG. 6C qRT-PCR demonstrating a reduction in SIRT1 mRNA following FKBP-LsiRNA transfection compared to NT control.

FIG. 6D shows SIRT1 protein levels following ALM201 treatment. Datapoints are mean±SEM. n≥3. p<0.001 (one-way ANOVA).

FIGS. 7A and 7B illustrate the level of secretion of leptin, IL8 andTIMP Secretion after treatment with FKBP-L's therapeutic peptide,ALM201—A Ray Biotech cytokine array was used to measure cytokines in thespent medium of MDA231 cells after exposure to ALM201. Blots were thenquantitated by densitometric analysis using Ray Biotech software.

FIGS. 8A to 8C illustrate amino acid sequences of FKBP-L and derivativesand fragments thereof.

FIGS. 9A to 9E illustrate nucleic acid sequences encoding for FKBP-L anddeletion mutants and variants.

FIG. 10 illustrates subcutaneous adipose tissue from Fkbpl^(+/−) miceand demonstrates hypertrophic adipcocytes: Images of H&E stainedsubcutaneous adipose tissue in female mice aged 6-8 weeks. Adipocytesare significantly enlarged (hypertrophic) in mice from Fkbpl^(+/−) mice.

FIG. 11 illustrates FKBP-L mRNA levels increase upon stimulation of2T3-L1 cells to undergo adipogenesis. 3T3-L1 cells were stimulated withadipocyte medium and mRNA isolated both prior (day -2) and 3-12 daysafter stimulation. qRT-PCR was used to determine FKBP-L levels. FKBPLlevels were increased at day 3 following adipocyte differentiation SinceFKBP-L is regulated during adipogenesis, the data suggests that it isinvolved in the process. Knockdown of FKBP-L (as seen in mice) may leadto inhibition of adipocyte differentiation, leading to adipocytehypertrophy (observed in FIG. 10); resulting in enhanced inflammationworsening obesity and leading to insulin resistance.

FIG. 12 illustrates the FKBP-L peptide, AD-01 (SEQ ID NO: 10), abrogatesLPS-induced activation of NFkB in THP-1 monocytes—Cells were stimulatedwith 100 ng of LPS which results in activation of NFkB phosphorylation.AD-01 abrogated that increase—cell lysates were collected from THP-1monocytes 6 hour after treatment and subjected to western blot analysisusing specific antibodies indicated.

FIG. 13 illustrates the FKBP-L peptide, AD-01, abrogates LPS-inducedactivation of IL-1β inTHP-1 monocytes—Cells were stimulated with 1000 ngof LPS. 24 h later condition medium was collected to assess secretion ofcytokines—IL-16, measured by ELISA was significantly increased by LPSand was significantly abrogated by AD-01.

FIG. 14 illustrates low serum FKBP-L, measured by ELISA, is associatedwith childhood obesity.

FIG. 15 illustrates low serum FKBP-L, measured by ELISA, correlates withhigh BMI score in children.

FIG. 16 illustrates that male C57BL/6N mice, age 8 weeks, fed a HFD, orstandard chow, could be prevented from gaining weight when mice weretreated via i.v. injection of naked plasmid DNA containing the fulllength FKBP-L gene (pFKBPL) or plasmid DNA containing the full lengthFKBP-L gene delivered using a novel peptide delivery system, RALA(RALA-pFKBPL), when these were delivered once weekly.

A) Weight change (g) of male C57BL/6N mice during four weeks of HFDfeeding with no treatment (control; n=4), or weekly IV pFKBPL (n=5) orIV RALA-pFKBPL (n=5);

B) Weight change (g) of male C57BL/6N mice during four weeks of standardchow feeding with no treatment (control; n=4), or weekly IV pFKBPL (n=5)or IV RALA-pFKBPL (n=4), wherein results are displayed as mean±SEM.Statistical analysis was by two-way ANOVA with Bonferroni post hoc test,where * represents p<0.05, ** represents p<0.01, and *** representsp<0.001 for control vs IV RALA-pFKBPL, and where + represents p<0.05, ++represents p<0.01, and +++ represents p<0.001 for control vs IV pFKBPL.

FIG. 17 illustrates that male C57BL/6N mice, age 8 weeks, which had beenfed a HFD, or standard chow, for the following 14 weeks could be inducedto lose weight when mice were treated via i.v. injection of nakedplasmid DNA containing the full length FKBPL gene (pFKBPL) or plasmidDNA containing the full length FKBPL gene delivered using a novelpeptide delivery system, RALA (RALA-pFKBPL), when these were deliveredonce weekly. Control mice received no treatment. A) Weight change (g) ofmale C57BL/6N mice during three weeks of either no treatment (control;n=3), or weekly IV pFKBPL (n=4) or IV RALA-pFKBPL (n=4); following 14weeks of HFD feeding;

B) Weight change (g) of male C57BL/6N mice during three weeks of eitherno treatment (control; n=4), or weekly IV pFKBPL (n=5) or IV RALA-pFKBPL(n=6); following 14 weeks of standard chow feeding.

Results are displayed as mean±SEM. Statistical analysis was by two-wayANOVA with Bonferroni post hoc test, where * represents p<0.05, **represents p<0.01, and *** represents p<0.001 for control vs IVRALA-pFKBPL.

FIG. 18 illustrates the same data as FIG. 17, but is presented as % oforiginal body weight—there is approximately a 5% decrease in body weightwith RALA-pFKBPL compared to control mice and the 5% decrease ismaintained for the 3 weeks of treatment; this decrease is in line withEuropean Medicines Agency Guidelines for medicinal products used inweight management.

DETAILED DESCRIPTION

The following detailed description and the accompanying drawings towhich it refers are intended to describe some, but not necessarily all,examples or embodiments of the invention. The described embodiments areto be considered in all respects only as illustrative and notrestrictive.

The contents of this detailed description and the accompanying drawingsdo not limit the scope of the invention in any way.

Definitions

Abbreviations for amino acid residues are the standard 3-letter and/or1-letter codes used in the art to refer to one of the 20 common L-aminoacids. Notwithstanding that the numerical ranges and parameters settingforth the broad scope of the invention are approximations, the numericalvalues set forth in the specific examples are reported as precisely aspossible. Any numerical value, however, inherently contains certainerrors necessarily resulting from the standard deviation found in theirrespective testing measurements. Moreover, all ranges disclosed hereinare to be understood to encompass any and all subranges subsumedtherein. For example, a stated range of “1 to 10” should be consideredto include any and all subranges between (and inclusive of) the minimumvalue of 1 and the maximum value of 10. Additionally, any referencereferred to as being “incorporated herein” is to be understood as beingincorporated in its entirety.

As used in this specification, the singular forms “a,” “an,” and “the”include plural referents unless expressly and unequivocally limited toone referent. The term “or” is used interchangeably with the term“and/or” unless the context clearly indicates otherwise. Also, the terms“portion” and “fragment” are used interchangeably to refer to parts of apolypeptide, nucleic acid, or other molecular construct.

As used herein, the term FKBP-L polypeptides and nucleic acids thatencode FKBP-L are used in the specification according to its broadestmeaning. FKBP-L designates the naturally occurring proteins as describedin WO2007141533 which include those having the following sequences:

SEQ ID No. 2: METPPVNTIGEKDTSQPQQEWEKNLRENLDSVIQIRQQPRDPPTETLELEVSPDPASQILEHTQGAEKLV AELEGDSHKSHGSTSQMPEALQASDLWYCPDGSFVKKIVIRGHGLDKPKLGSCCRVLALGFPFGSGPPEG WTELTMGVGPWREETWGELIEKCLESMCQGEEAELQLPGHTGPPVGLTLASFTQGRDSWELETSEKEALA REERARGTELFRAGNPEGAARCYGRALRLLLTLPPPGPPERTVLHANLAACQLLLGQPQLAAQSCDRVLE REPGHLKALYRRGVAQAALGNLEKATADLKKVLAIDPKNRAAQEELGKVVIQGKNQDAGLAQGLRKMFG SEQ ID No. 29:METPPVNTIGEKDTSQPQQEWEKNLRENLDSVIQI RQQPRDPPTETLELEVSPDPASQILEHTQGAEKLVAELEGDSHKSHGSTSQMPEALQASDLWYCPDGSFV KKIVIRGHGLDKPKLGSCCRVLALGFPFGSGPPEGWTELTMGVGPWREETWGELIEKCLESMCQGEEAEL QLPGHSGPPVRLTLASFTQGRDSWELETSEKEALAREERARGTELFRAGNPEGAARCYGRALRLLLTLPP PGPPERTVLHANLAACQLLLGQPQLAAQSCDRVLEREPGHLKALYRRGVAQAALGNLEKATADLKKVLAI DPKNRAAQEELGKVVIQGKNQDAGLAQGLRKMFGFKBP-L (SEQ ID NO: 2) can be encoded by the nucleotide sequence:(Accesion number NM_022110) atggagacgc caccagtcaa tacaattggagaaaaggacacctctcagcc gcaacaagag tgggaaaaga accttcgggagaaccttgattcagttattc agattaggca gcagccccgagaccctccta ccgaaacgct tgagctggaagtaagcccagatccagccag ccaaattcta gagcatactc aaggagctgaaaaactggttgctgaacttg aaggagactc tcataagtctcatggatcaa ccagtcagat gccagaggcccttcaagcttctgatctctg gtactgcccc gatgggagct ttgtcaagaagatcgtaatccgtggccatg gcttggacaa acccaaactaggctcctgct gccgggtact ggctttggggtttcctttcggatcagggcc gccagagggc tggacagagc taactatggggtagggccatggagggagg aaacttgggg ggagctcatagagaaatgct tggagtccat gtgtcaaggtgaggaagcagagcttcagct gcctgggcac tctggacctc ctgtcaggctcacactggcatccttcactc aaggccgaga ctcctgggagctggagacta gcgagaagga agccctggccagggaagaacgtgcaagggg cacagaacta tttcgagctg ggaaccctgaaggagctgcccgatgctatg gacgggctct tcggctgctcctgactttac ccccacctgg ccctccagaacgaactgtccttcatgccaa tctggctgcc tgtcagttgt tgctagggcagcctcagttggcagcccaga gctgtgaccg ggtgttggagcgggagcctg gccatttaaa ggccttataccgaaggggggttgcccaggc tgcccttggg aacctggaaa aagcaactgctgacctcaagaaggtgctgg cgatagatcc caaaaaccgggcagcccagg aggaactggg gaaggtggtcattcaggggaagaaccagga tgcagggctg gctcagggtc tgcgcaagatgtttggctgattaaaagtta aaccttaaaa gagaaaaaaa aaaaaaaA FKBP-L variant (SEQ ID NO: 29) may beencoded by a nucleic acid seqence comprising:atggagacgc caccagtcaa tacaattggagaaaaggacacctctcagcc gcaacaagag tgggaaaaga accttcgggagaaccttgattcagttattc agattaggca gcagccccgagaccctccta ccgaaacgct tgagctggaagtaagcccagatccagccag ccaaattcta gagcatactc aaggagctgaaaaactggttgctgaacttg aaggagactc tcataagtctcatggatcaa ccagtcagat gccagaggcccttcaagcttctgatctctg gtactgcccc gatgggagct ttgtcaagaagatcgtaatccgtggccatg gcttggacaa acccaaactaggctcctgct gccgggtact ggctttggggtttcctttcggatcagggcc gccagagggc tggacagagc taactatgggcgtagggccatggagggagg aaacttgggg ggagctcatagagaaatgct tggagtccat gtgtcaaggtgaggaagcagagcttcagct gcctgggcac actggacctc ctgtcgggctcacactggcatccttcactc aaggccgaga ctcctgggagctggagacta gcgagaagga agccctggccagggaagaacgtgcaagggg cacagaacta tttcgagctg ggaaccctgaaggagctgcccgatgctatg gacgggctct tcggctgctcctgactttac ccccacctgg ccctccagaacgaactgtccttcatgccaa tctggctgcc tgtcagttgt tgctagggcagcctcagttggcagcccaga gctgtgaccg ggtgttggagcgggagcctg gccatttaaa ggccttataccgaaggggggttgcccaggc tgcccttggg aacctggaaa aagcaactgctgacctcaagaaggtgctgg cgatagatcc caaaaaccgggcagcccagg aggaactggg gaaggtggtcattcaggggaagaaccagga tgcagggctg gctcagggtc tgcgcaagatgtttggctgattaaaagtta aaccttaaaa gagaaaaaaa aaaaaaa

Further derivatives and fragments are illustrated in FIG. 8. Inembodiments a FKBP-L derivative can be an amino acid sequence having atleast 90% identity to SEQ ID NO: 2 and includes sequences that have 91,91.5, 92, 92.5, 93, 93.5. 94, 94.5, 95, 95.5, 96, 96.5, 97, 97.5, 98,98.5, 99, 99.5 percent identity to SEQ ID NO: 2.

Nucleic acids that encode FKBP-L or fragments thereof are provided, forexample, by SEQ ID Nos: 30-39, or fragments thereof, for example thatcan encode a polypeptide having an amino acid sequence as set forth inSEQ ID NOs:1 to 29. In embodiments, degenerate sequences wherein thethird ‘wobble’ position of the encoded amino acid codon is altered maybe provided such that the degenerate nucleic acid sequences still encodethe polypeptides of the invention with the amino acid sequences setforth herein.

As used herein, the term “biologically active fragments or derivative ofFKBP-L polypeptide”, is used to refer to a polypeptide that displays thesame or similar amount and type of activity as the full-length FKBP-Lpolypeptide. Suitably, such a fragment may comprise or consist of atleast 6, suitably 12, more suitably 18 contiguous amino acids of SEQ IDNO: 10 or a nucleic acid that encodes at least 18 contiguous amino acidsof SEQ ID: 10. In embodiments, a fragment can be for example up to 200amino acids of SEQ ID NO: 2 or SEQ ID NO: 29 or a nucleic acid thatencodes up to 200 amino acids of SEQ ID NO: 2 or SEQ ID NO: 29. Inembodiments an FKBP-L fragment can be any length that retains itsanti-obesity activity such that it can be used according to the presentinvention.

Thus, biologically active fragments or derivatives of FKBP-L polypeptidecan comprise the amino acid sequence shown in any one of SEQ ID NOs: 3to 7, or 11 to 28, or an amino acid sequence at least 90% identical tothe amino acid sequence shown in any one of SEQ ID NOs: 1 to 29 asdescribed in WO2007141533, the entire disclosure of which isexpressively incorporated herein by reference. As discussed byWO2007141533, truncated mutants, for example 448, 458, 486, 4151, 4200can provide significant FKBP-L activity.

In embodiments biologically active fragments or derivatives of FKBP-Lpolypeptide can comprise an amino acid sequence that are at least 91%,91.5%, 92%, 92.5%, 93%, 93.5%, 94%, 94.5%, 95%, 95.5%, 96%, 96.5%, 97%,97.5%, 98%, 98.5%, 99%, 99.5% identical to SEQ ID No. 2. Suitablyderivatives may be provided by incorporation of deliberate amino acidsubstitutions in the polypeptide on the basis of similarity in polarity,charge, solubility, hydrophobicity or hydrophilicity of the amino acidresidues as long as specificity of function (activity) is retained.Further, polypeptides may be modified by the addition of a functionalgroup, for example PEG or the like.

Moreover, derivatives can include analogues of the natural FKBP-L aminoacid sequence which are capable of providing similar functionalactivity. Derivatives can also include multimeric peptides such thatFKBP-L polypeptides are provided as multimers through the formation ofdisulphide bonds between monomers of the FKBP-L polypeptide. Derivativescan also include wherein the polypeptide is linked to a coupling partnersuch as a label, drug, or carrier or transport molecule. FKBP-Lderivatives can also include fusion proteins, for example wherein FKBP-Lis linked to an antibody to allow targeting or to facilitatepurification as provided for example, in SEQ ID No. 1.

Suitably, derivatives can provide increased half-life or stabilityagainst proteolysis through addition of further moieties or byincorporation of an unnatural amino acid or via backbone modifications.Derivatives may also be provided by providing reverse or retro analoguesof the FKBP-L polypeptides and/or their synthetic derivatives. Suitablyderivatives of FKBP-L can be provided as pro-drugs of the polypeptideswherein following administration, for example, by intravenous,subcutaneous or intramuscular injection or via the intranasal cavity,they can be metabolised by plasma proteases to provide an active form ofFKBP-L. Ways of forming pro-drugs would be known to those of skill inthe art for example as discussed in WO 2007/141533 at pages 48-53incorporated herein by reference.

As used herein, biologically active FKBP-L or biologically activefragments or derivatives of FKBP-L may be tested for activity incomparison to full length FKBP-L using in vitro or in vivo assays.Suitable assays to demonstrate anti-obesity effects are provided by theexamples provided herein.

As known in the art, “protein”, “peptides” and “polypeptide” are chainsof amino acids (typically L-amino acids) whose alpha-carbons are linkedthrough peptide bonds formed by condensation reactions between thecarboxyl group of the alpha-carbon of one amino acid and the amino groupof the alpha-carbon of another amino acid. Typically, as used herein,the term polypeptide and peptide have been used interchangeably. A“nucleic acid” is a polynucleotide such as deoxyribonucleic acid (DNA)or ribonucleic acid (RNA). The term is used to include single and doublestranded nucleic acids and RNA and DNA made from nucleotide ornucleoside analogues.

The term “composition”, as in pharmaceutical composition, is intended toencompass a product comprising the active ingredient(s), suitably aFKBP-L polypeptide or fragment or derivative thereof or a nucleic acidencoding the same, and the inert ingredient(s) that make up the carrier,as well as any product which results, directly or indirectly, fromcombination, complexation or aggregation of any two or more of theingredients, or from dissociation of one or more of the ingredients, orfrom other types of reactions or interactions of one or more of theingredients. Accordingly, the pharmaceutical compositions utilized inthe present invention encompass any composition made by admixing anactive ingredient and one or more pharmaceutically acceptable carriers.

As used herein, the term “pharmacologically effective amount” (including“therapeutically effective amount”) means an amount of a peptideaccording to the invention that is sufficient to induce a desiredtherapeutic or biological effect.

As used herein, the term “therapeutically effective amount” means theamount of a peptide of the invention that will elicit a biological ormedical response in the mammal that is being treated by a medical doctoror other clinician.

The terms “therapy” and “treatment” may include treatment and/orprophylaxis. As used herein all references to polypeptides according tothe invention, including a specific chemical formula or name, areintended to include all pharmaceutically acceptable salts, solvates,hydrates, polymorphs, prodrugs, metabolites, stereoisomers, andtautomeric isomers thereof.

As used herewith, the disease Type 2 Diabetes, which isnon-insulin-dependent diabetes mellitus as diagnosed according tocriteria published in the Report of the Expert Committee on theDiagnosis and Classification of Diabetes Mellitus whereby fasting plasmaglucose level is greater than or equal to 126 milligrams per deciliter,and latent autoimmune diabetes mellitus of adults (LADA).

The term “metabolic disorders” refers to glucose and lipid regulatorydisorders, including insulin resistance and defective secretion ofinsulin by pancreatic beta cells, and may further include conditions andstates such as abdominal obesity, dyslipidemia, hypertension, glucoseintolerance or a prothrombitic state, and which may further result indisorders such as hyperlipidemia, obesity, diabetes, insulin resistance,glucose intolerance, hyperglycemia, and hypertension.

The compositions and methods disclosed herein can be used for bothmedical applications and animal husbandry or veterinary applications.

Typically, the methods are used in humans, but may also be used in othermammals.

The primary applications of the present invention involve humanpatients, but the present invention may be applied to laboratory, farm,zoo, wildlife, pet, sport or other animals.

As used herein, the term obesity and related disorders refer todisorders and conditions characterized by excess body weight and/orexcess food intake, metabolic disorders, in particular involving energyhomeostasis and metabolism such as for example diabetes, in particulartype 2 diabetes; dyslipidemia; fatty liver; hypercholesterolemia;hypertriglyceridemia; hyperuricacidemia; impaired glucose tolerance;impaired fasting glucose; insulin resistance syndrome; and metabolicsyndrome; food intake such as for example hyperphagia; binge eating;bulimia; and compulsive eating.

As used herein, the terms “identity” or “percent identity”, refer tosequence identity between two amino acid sequences or between twonucleic acid sequences. Percent identity can be determined by aligningtwo sequences and refers to the number of identical residues (amino acidor nucleotide), a position shared by the compared sequences. Sequencealignment and comparison may be conducted using the algorithms standardin the art.

Suitable packages {e.g. Smith and Waterman, 1981, Adv. Appl. Math.2:482; Needleman and Wunsch, 1970, J. Mol. Biol. 48:443; Pearson andLipman, 1988, Proc. Natl. Acad. Sci., USA, 85:2444) or computerizedversions of these algorithms (Wisconsin Genetics Software PackageRelease 7.0, Genetics Computer Group, 575 Science Drive, Madison, Wis.)publicly available as BLAST and FASTA. Also, ENTREZ, available throughthe National Institutes of Health, Bethesda Md., may be used forsequence comparison. When utilizing BLAST and Gapped BLAST programs, thedefault parameters of the respective programs (e.g., BLASTN; availableat the Internet site for the National Center for BiotechnologyInformation) may be used. In one embodiment, the percent identity of twosequences may be determined using GCG with a gap weight of 1, such thateach amino acid gap is weighted as if it were a single amino acidmismatch between the two sequences. Alternatively, the ALIGN program(version 2.0), which is part of the GCG (Accelrys, San Diego, Calif.)sequence alignment software package may be used.

As used herein, the term “conserved residues” refers to amino acids thatare the same among a plurality of proteins having the same structureand/or function. A region of conserved residues may be important forprotein structure or function. Thus, contiguous conserved residues asidentified in a three-dimensional protein may be important for proteinstructure or function. To find conserved residues, or conserved regionsof 3-D structure, a comparison of sequences for the same or similarproteins from different species, or of individuals of the same species,may be made.

As used herein, the term at least 90% identical thereto includessequences that range from 90 to 99.99% identity to the indicatedsequences and includes all ranges in between. Thus, the term at least90% identical thereto includes sequences that are 91, 91.5, 92, 92.5,93, 93.5. 94, 94.5, 95, 95.5, 96, 96.5, 97, 97.5, 98, 98.5, 99, 99.5percent identical to the indicated sequence. The determination ofpercent identity is determined using the algorithms described herein.

As used herein, a polypeptide or protein “domain” comprises a regionalong a polypeptide or protein that comprises an independent unit.Domains may be defined in terms of structure, sequence and/or biologicalactivity. In one embodiment, a polypeptide domain may comprise a regionof a protein that folds in a manner that is substantially independentfrom the rest of the protein. Domains may be identified using domaindatabases such as, but not limited to PFAM, PRODOM, PROSITE, BLOCKS,PRINTS, SBASE, ISREC PROFILES, SAMRT, and PROCLASS.

The inventors have determined that a FKBP-L polypeptide, or abiologically active fragment or a derivative of FKBP-L or a derivativeof a fragment of FKBP-L or a nucleic acid encoding FKBP-L thereof, canmediate regulation of Sirtuin 1, a family of NAD+-dependent deacetylase.Sirtuin 1 is considered to be significant in metabolic diseases anddisorders. The inventors have also demonstrated that treatment withFKBP-L can reduce NFkB and IL-1β.

Thus, in certain embodiments the FKBP-L polypeptides of the presentinvention can be used to treat metabolic disorders. In particular it isconsidered that the FKBP-L polypeptides of the invention or expressionof nucleic acids that encode FKBP-L upon administration to an animalincluding man, will reduce body weight and/or body weight gain in thatanimal, and/or improve obesity-related disease.

Thus, in one embodiment, the present invention comprises an isolatedFKBP-L encoding nucleic acid or FKBP-L polypeptide, or a biologicallyactive fragment or derivative thereof, for use in the treatment ofobesity and obesity-related disorders.

The FKBP-L encoding nucleic acids and polypeptides of the presentinvention are particularly useful for treatment of obesity disordersand/or conditions characterized by excess body weight, including obesityand overweight (by promotion of weight loss, maintenance of weight loss,and/or prevention of weight gain, including medication-induced weightgain or weight gain subsequent to cessation of smoking), and diseases,disorders and/or conditions associated with obesity and/or overweight,such as insulin resistance; impaired glucose tolerance; type 2 diabetes;metabolic syndrome; dyslipidemia (including hyperlipidemia);hypertension; heart disorders (e.g. coronary heart disease, myocardialinfarction); cardiovascular disorders; nonalcoholic fatty liver disease(including non-alcoholic steatohepatitis); joint disorders (includingsecondary osteoarthritis); gastroesophageal reflux; sleep apnea;atherosclerosis; stroke; macro and micro vascular diseases; steatosis(e.g. in the liver); gall stones; and gallbladder disorders.

The FKBP-L encoding nucleic acids and polypeptides of the invention areconsidered to be useful for treatment of obesity and type 2 diabetes,more specifically obesity.

It will be understood that there are medically accepted definitions ofobesity and overweight. Subjects who are candidates for treatment by thepresent invention may be identified by, for example, measuring body massindex (BMI), which is calculated by dividing weight in kilograms byheight in meters squared, and comparing the result with the definitions.The recommended classifications for BMI in humans, adopted by the ExpertPanel on the Identification, Evaluation and Treatment of Overweight andObesity in Adults, and endorsed by leading organizations of healthprofessionals, are as follows: underweight<18.5 kg/m2, normal weight18.5-24.9 kg/m2, overweight 25-29.9 kg/m2, obesity (class 1) 3034.9kg/m2, obesity (class 2) 35-39.9 kg/m2, extreme obesity (class 3) is 40kg/m2 (Practical Guide to the Identification, Evaluation, and Treatmentof Overweight and Obesity in Adults, The North American Association forthe Study of Obesity (NAASO) and the National Heart, Lung and BloodInstitute (NHLBI) 2000). Modifications of this classification may beused for specific ethnic groups and for children.

Another alternative for assessing overweight and obesity is by measuringwaist circumference. There are several proposed classifications anddifferences in the cutoffs based on ethnic group. For instance,according to the classification from the International DiabetesFederation, men having waist circumferences above 94 cm (cut off foreuropids) and women having waist circumferences above 80 cm (cut off foreuropids) are at higher risk of diabetes, dyslipidemia, hypertension andcardiovascular diseases because of excess abdominal fat. Anotherclassification is based on the recommendation from the Adult TreatmentPanel III where the recommended cut-offs are 102 cm for men and 88 cmfor women. It will however be appreciated by persons skilled in the artthat obesity is inherently difficult to classify, and that the cut-offpoint for the definition of obesity is necessarily arbitrary, in partbecause body fatness is a continuum.

However, in general terms treatment according to the present inventiondesirably prevents or alleviates obesity to an extent whereby there isno longer a significant health risk to the patient.

In one embodiment, the FKBP-L polypeptides for use according to theinvention comprises the amino acids sequence shown in SEQ ID NO: 1, SEQID NO: 2 or SEQ ID NO: 29.

In a further embodiment, biologically active fragments or derivative ofFKBP-L polypeptide comprises the amino acid sequence shown in any one ofSEQ ID NOs: 3 to 7, or 11 to 28.

In one embodiment the biologically active fragments or derivative ofFKBP-L polypeptide can be

ALM201 (23 mer) (SEQ ID NO: 40): NH2-IRQQPRDPPTETLELEVSPDPAS-OH orAD-01 (24 mer) (SEQ ID NO: 10): NH2-QIRQQPRDPPTETLELEVSPDPAS-OH

In embodiments biologically active fragments of FKBP-L may be providedby determining an effective portion of n-terminal amino acid sequence ofnaturally occurring FKBP-L. Suitable embodiments are provided in FIG. 8.

The peptide may comprise or consist of a sequence that comprises atleast 18 continuous amino acids of SEQ ID No. 2 or 29. Alternatively, anucleic acid may be provided which can encode a polypeptide fragment asdescribed herein. In embodiments a nucleic acid encoding a fragment ofFKBP-L comprising or consisting of at least 18 continuous amino acids ofSEQ ID No. 2 or 29, can include degenerate nucleic acid moleculescomprising a degenerate variation on the third position of the aminoacid code such that the same amino acid is encoded to generate sequence.

In embodiments a peptide mimetic of a polypeptide sequence of theinvention can be provided which has functional activity. Suitably, theFKBP-L polypeptide can be provided as a cyclic peptide or a peptidecontaining a D or unnatural amino acids, the peptide may be linked toantibodies, carbohydrates, oligosaccharides, polysaccharides,glycolipids, nucleosides or nucleotides or part thereof or smallmolecules. Further, the FKBP-L polypeptides of the invention can bechemically modified and include isomeric or racemic forms.

Targeting systems such as antibody or cell specific ligands can be usedto target FKBP-L to specific cells. For example, targeting systems canbe covalently linked to a peptide sequence or to a drug delivery vehicleincluding the polypeptide sequence for example liposomes, microsomes,microparticles, microcapsules, nanopolymers or the like.

Nucleic acids of the present invention may be provided via an expressionsystem. Nucleic acid constructs that encode FKBP-L or fragments orderivatives thereof may comprise DNA or RNA and may be producedrecombinantly, synthetically, or by any other techniques as known in theart. Suitably a nucleic acid of the invention may be provided in avector, for example an expression vector. Suitably, the nucleic acid ofthe invention may be operably linked to a control sequence such that thecontrol sequence can provide expression of the nucleic acid in a host.Suitable a control sequence may include a mammalian promoter sequence,for example a constitutive mammalian promoter. Suitably a promoter maynot be constitutive, but inducible, for example by particulardevelopmental or other factors, for example metal ions, external drugs,hormones, enzyme substrates or the like. Suitably, viral promoters, forexample CMV promoter, SV40 promoter, or LTR, HBV, HCV, HSV, HPV, EBV,HTLV, HIV promoters could be used. Enhancer and other regulatoryelements may also be provided in a vector. A vector that may be utilisedmay include viral vectors, yeast vectors, phage, chromosomes, artificialchromosomes, plasmids, cosmid DNA, liposomes, polypexes, or cells suchas stem cells, mesenchymal cells or the like. Suitably viral vectors mayinclude adenovirus, vaccina virus, lentivirus, retrovirus or baclovirus.

Suitably a vector provides a nucleic acid into a host cells to allowexpression of the FKBP-L. Suitably, the host cell may provide for posttranslational modification of the expressed FKBP-L, for exampleglycosylation, disulphide bond formation, post translationalmodification and the like. Details of known techniques for thepreparation of nucleic acids may be obtained from, for example CurrentProtocols in Molecular Biology, 2^(nd) ed., Ausubel et al. eds., JohnWiley & Sons, 1992 and, Molecular Cloning: a Laboratory Manual: 3^(rd)edition Sambrook et al., Cold Spring Harbour Laboratory Press, 2000.Suitably the methods as discussed at pages 58 to 67 of WO2007/141533could be utilised to provide nucleic acids encoding FKBP-L.

In embodiments RALA as discussed by WO 2014/087023 and 30mer amphipathicpeptides can be used to deliver the FKBP-L gene/nucleic acid encodingFKBP-L. Suitably RALA as discussed by WO 2014/087023 and 30meramphipathic peptides can be used to deliver the FKBP-L gene/nucleic acidencoding FKBP-L via IV injection for systemic delivery.

RALA allows the delivery of FKBP-L systemically and/or to targeted cellsfor example to cells associated to obesity related disorders.

Methods of Making Polypeptides

A. Solid-State Peptide Synthesis

Polypeptides according to the present invention can be synthesized bystandard solid-state peptide synthesis methods, such as those describedin M. Bodanszky, “Principles of Peptide Synthesis” (Springer-Verlag,Berlin, 2d ed., 1993). This involves synthesis on an insoluble polymersuch as a styrene-divinylbenzene copolymer that is derivatized. Thesequence of reactions used is standard.

B. Genetic Engineering

Polypeptides/peptides according to the present invention can be preparedby genetic engineering. In general, a method of producing asubstantially purified peptide according to the present invention havinga physiological activity comprises the steps of: (1) culturing a hostcell transfected with a vector comprising DNA encoding the peptideoperably linked to at least one control element that influences theexpression of the DNA; and (2) isolating the peptide produced by thehost cell to produce the substantially purified peptide. Expressionmethods are described in, e.g., D. V. Goeddel, “Gene ExpressionTechnology” (Academic Press, San Diego, 1991). In general, such methodsare well known in the art.

Once expressed, the polypeptides/peptides of the present invention canbe isolated by standard protein isolation techniques includingion-exchange chromatography on resins such as diethylaminoethylcelluloseor carboxymethylcellulose, chromatography on size exclusion media (gelfiltration), isoelectric focusing, chromatofocusing, and other standardmethods, such as those described in R. K. Scopes, “Protein Purification:Principles and Practice” (3d Ed., Springer-Verlag, New York, 1994).

Polypeptides/peptides of the present invention may be in the form of anypharmaceutically acceptable salt.

The term “pharmaceutically acceptable salts” refers to salts preparedfrom pharmaceutically acceptable non-toxic bases or acids includinginorganic or organic bases and inorganic or organic acids (see “Handbookof Pharmaceutical Salts: Properties, Selection and Use”, P. H. Stahl, P.G. Wermuth, IUPAC, Wiley-VCH, 2002). Salts derived from inorganic basesinclude aluminum, ammonium, calcium, copper, ferric, ferrous, lithium,magnesium, manganic salts, manganous, potassium, sodium, zinc, and thelike. Particularly preferred are the ammonium, calcium, lithium,magnesium, potassium, and sodium salts. Salts derived frompharmaceutically acceptable organic non-toxic bases include salts ofprimary, secondary, and tertiary amines, substituted amines includingnaturally occurring substituted amines, cyclic amines, and basic ionexchange resins, such as arginine, betaine, caffeine, choline,N,N′-dibenzylethylenediamine, diethylamine, 2-diethylaminoethanol,2-dimethylaminoethanol, ethanolamine, ethylenediamine,N-ethyl-morpholine, N-ethylpiperidine, glucamine, glucosamine,histidine, hydrabamine, isopropylamine, lysine, methylglucamine,morphoine, piperazine, piperidine, polyamine resins, procaine, purines,theobromine, triethylamine, trimethylamine, tripropylamine,tromethamine, and the like. When the peptide of the present invention isbasic, acid addition salts may be prepared from pharmaceuticallyacceptable non-toxic acids, including inorganic and organic acids. Suchacids include acetic, benzenesulfonic, benzoic, camphorsulfonic,carboxylic, citric, ethanesulfonic, formic, fumaric, gluconic, glutamic,hydrobromic, hydrochloric, isethionic, lactic, maleic, malic, mandelic,methanesulfonic, malonic, mucic, nitric, pamoic, pantothenic,phosphoric, propionic, succinic, sulfuric, tartaric, p-toluenesulfonicacid, trifluoroacetic acid, and the like. Acid addition salts ofpolypeptides of the present invention are prepared in a suitable solventfor the peptide and an excess of an acid, such as hydrochloric,hydrobromic, sulfuric, phosphoric, acetic, trifluoroacetic (TFA),citric, tartaric, maleic, succinic or methanesulfonic acid. Acetate,ammonium acetate and TFA acid salt forms may be especially useful.

Pharmaceutical Compositions.

The invention provides a pharmaceutical composition that includes one ormore polypeptides of the present invention and a pharmaceuticallyacceptable carrier. When formulated with a pharmaceutically acceptablecarrier, the compound of the invention may be present in thepharmaceutical composition in a concentration from 0.0001 to 99.5%, suchas from 0.001 to 95%, by weight of the total composition. The choice ofcarrier is within the knowledge of a person skilled in the art anddepends on, for instance, the mode of administration, the dosage form,and the physical properties of the active compound, such as solubilityand stability. The term “carrier” as used herein relates to atherapeutically inactive ingredient. The dosage form may be a solid,semi-solid, liquid or self-gelling system. The formulation may be animmediate and/or modified release, including delayed-, sustained-,pulsed-, controlled-, targeted and programmed release formulation. Thecarrier may be a liquid formulation, and is preferably a buffered,isotonic, aqueous solution. Pharmaceutically acceptable carriers alsoinclude excipients, such as diluents, carriers and the like, andadditives, such as stabilizing agents, preservatives, solubilizingagents, buffers and the like, as hereafter described. Formulationexcipients may include polyvinylpyrrolidone, gelatin, hydroxy propylcellulose (HPC), acacia, polyethylene glycol, mannitol, sodium chlorideand sodium citrate. For injection or other liquid administrationformulations, water containing at least one or more bufferingconstituents is preferred, and stabilizing agents, preservatives andsolubilizing agents may also be employed. A preferred embodimentincludes a liquid formulation containing 1, 10, or 25 mg/mL peptide in asolution composed of 10 mM sodium phosphate, 0.8% (w/v) NaCl, 0.05%(w/v) polysorbate 20, in water for injection (pH 6).

For solid administration formulations, any of a variety of thickening,filler, bulking and carrier additives may be employed, such as starches,sugars, cellulose derivatives, fatty acids and the like. For topicaladministration formulations, any of a variety of creams, ointments,gels, lotions and the like may be employed.

For most pharmaceutical formulations, non-active ingredients willconstitute the greater part, by weight or volume, of the preparation.For pharmaceutical formulations, it is also contemplated that any of avariety of measured-release, slow-release or sustained-releaseformulations and additives may be employed, so that the dosage may beformulated so as to provide delivery of a peptide of the presentinvention over a period of time. In general, the actual quantity ofpolypeptides of the present invention administered to a patient willvary between fairly wide ranges depending on the mode of administration,the formulation used, and the response desired. In practical use, thepeptides of the invention can be combined as the active ingredient in anadmixture with a pharmaceutical carrier according to conventionalpharmaceutical compounding techniques. The carrier may take a widevariety of forms depending on the form of preparation desired foradministration, for example, oral, parenteral (including intravenous),urethral, vaginal, nasal, buccal, sublingual, or the like.

In preparing the compositions for an oral dosage form, any of the usualpharmaceutical media may be employed, such as, for example, water,glycols, oils, alcohols, flavoring agents, preservatives, coloringagents and the like in the case of oral liquid preparations such as, forexample, suspensions, elixirs and solutions; or carriers such asstarches, sugars, microcrystalline cellulose, diluents, granulatingagents, lubricants, binders, disintegrating agents and the like in thecase of oral solid preparations such as, for example, powders, hard andsoft capsules and tablets. Because of their ease of administration,tablets and capsules represent an advantageous oral dosage unit form. Ifdesired, tablets may be coated by standard aqueous or nonaqueoustechniques. The amount of active peptide in such therapeutically usefulcompositions is such that an effective dosage will be obtained. Inanother dosage unit form, sublingual constructs may be employed, such assheets, wafers, tablets or the like.

The tablets, pills, capsules, and the like may also contain a bindersuch as povidone, gum tragacanth, acacia, corn starch or gelatin;diluents; fillers such as microcrystalline cellulose; excipients such asdicalcium phosphate; a disintegrating agent such as corn starch, potatostarch or alginic acid; preservatives; colorants; a lubricant such asmagnesium stearate; and a sweetening agent such as sucrose, lactose orsaccharin. When a dosage unit form is a capsule, it may contain, inaddition to materials of the above type, a liquid carrier such as fattyoil. Various other materials may be utilized as coatings or to modifythe physical form of the dosage unit. For instance, tablets may becoated with shellac, sugar or both. A syrup or elixir may contain, inaddition to the active ingredient, sucrose as a sweetening agent, methyland propylparabens as preservatives, a dye and a flavoring such ascherry or orange flavor.

If formulated for oral delivery, the peptide is preferably formulatedand made such that it is encased in an enteric protectant, morepreferably such that it is not released until the tablet or capsule hastransited the stomach, and optionally has further transited a portion ofthe small intestine. In the context of this application it will beunderstood that the term enteric coating or material refers to a coatingor material that will pass through the stomach essentially intact butwill disintegrate after passing through the stomach to release theactive drug substance. Materials that may be used includes celluloseacetate phthalate, hydroxypropylmethylethylcellulose succinate,hydroxypropylmethylcellulose phthalate, polyvinyl acetate phthalate, andmethacrylic acidmethyl methacrylate copolymer. The enteric coatingemployed promotes dissolution of the dosage form primarily at a siteoutside the stomach, and may be selected such that the enteric coatingdissolves at a pH of approximately at least 5.5, more preferable at a pHof from about 6.0 to about 8.0. Any of a variety of permeation enhancersmay be employed, to increase uptake in the intestines upon dissolutionof the enteric coating. In one aspect, permeation enhancers increaseeither paracellular or transcellular transport systems.

Representative, non-limiting examples of such permeation enhancersinclude calcium chelators, bile salts (such as sodium cholate), andfatty acids. In some embodiments, peptides or polypeptides that act assubstrates for intestinal proteases are further added. Peptides may alsobe administered parenteral. Solutions or suspensions of these activepeptides may for instance be prepared in water mixed with for instancehydroxy-propylcellulose. Dispersions can also be prepared in glycerol,liquid polyethylene glycols and mixtures thereof in oils. Thesepreparations may optionally contain a preservative to prevent the growthof microorganisms.

The pharmaceutical forms suitable for injectable use include sterileaqueous solutions or dispersions and sterile powders for theextemporaneous preparation of sterile injectable solutions ordispersions. In all cases, the form must be sterile and must be fluid tothe extent that it may be administered by syringe. The form must bestable under the conditions of manufacture and storage and must bepreserved against the contaminating action of microorganisms such asbacteria and fungi. The carrier can be a solvent or dispersion mediumcontaining, for example, water, ethanol, a polyol, for example glycerol,propylene glycol or liquid polyethylene glycol, suitable mixturesthereof, and vegetable oils.

Polypeptides or nucleic acids encoding the same of the present inventionmay be therapeutically applied by means of nasal administration. By“nasal administration” is meant any form of intranasal administration ofany of the polypeptides of the present invention. The polypeptides maybe in an aqueous solution, such as a solution including saline, citrateor other common excipients or preservatives. The polypeptides may alsobe in a dry or powder formulation. Suitably the polypeptides for nasaladministration may be cyclic peptides.

If in an aqueous solution, the polypeptides may be appropriatelybuffered by means of saline, acetate, phosphate, citrate, acetate orother buffering agents, which may be at any physiologically acceptablepH, such as from about pH 4 to about pH 7. A combination of bufferingagents may also be employed, such as phosphate buffered saline, a salineand acetate buffer, and the like. In the case of saline, a 0.9% salinesolution may be employed. In the case of acetate, phosphate, citrate,and the like, a 50 mM solution may be employed. In addition to bufferingagents, a suitable preservative may be employed, to prevent or limitbacteria and other microbial growth. One such preservative that may beemployed is 0.05% benzalkonium chloride.

The polypeptides or nucleic acids encoding the same of the presentinvention may be therapeutically administered by means of an injectionof a sustained release formulation. In general, any of a number ofinjectable and bioerodible polymers may be employed in a sustainedrelease injectable formulation. Alternatively other sustained releaseformulations may be employed, including formulations permittingsubcutaneous injection, which other formulations may include one or moreof nano/microspheres, liposomes, emulsions (such as water-in-oilemulsions), gels, insoluble salts or suspensions in oil. The formulationmay be such that an injection is required on a daily, weekly, monthly orother periodic basis, depending on the concentration and amount ofpeptide, the sustained release rate of the materials employed, and otherfactors known to those of skill in the art.

Routes of Administration.

If a composition including one or more polypeptides of the presentinvention or a nucleic acid encoding the same is administered byinjection, the injection may be intravenous, subcutaneous,intramuscular, intraperitoneal or other means known in the art. Ingeneral, any route of administration by which the peptides of inventionare introduced across an epidermal layer of cells may be employed.Administration means may thus include administration through mucousmembranes, buccal administration, oral administration, dermaladministration, inhalation administration, nasal administration,urethral administration, vaginal administration, topical administrationto a site to be treated and the like.

Therapeutically Effective Amount.

In general, the actual quantity of polypeptide/peptide of the presentinvention or nucleic acid to be administered to a patient will varybetween fairly wide ranges depending upon the mode of administration,the patient (including weight, sex, health condition and diet), theformulation used, and the response desired. The dosage for treatment isadministration, by any of the foregoing means or any other means knownin the art, of an amount sufficient to bring about the desiredtherapeutic effect. The polypeptides/peptides of the present inventionare highly active. For example, the polypeptide/peptide can beadministered (as a single dose or in divided daily doses) at about0.001, 0.01, 0.5, 1, 5, 50, 100, 500, 1000, 5000, 10000, or 25000 ug/kgbody weight, depending on the specific polypeptide /peptide selected,the desired therapeutic response, the route of administration, theformulation and other factors known to those of skill in the art.

The invention is further intended to include prodrugs of the presentpolypeptides /peptides, which on administration undergo chemicalconversion by metabolic processes before becoming active pharmacologicalpeptides. In general, such prodrugs will be functional derivatives ofthe present peptides, which are readily convertible in vivo. Prodrugsare any covalently bonded compounds, which release the active parentpeptide drug in vivo. Conventional procedures for the selection andpreparation of suitable prodrug derivatives are described, for example,in “Design of Prodrugs”, ed. H. Bundgaard, Elsevier, 1985.

Certain modifications of peptides of the present invention may be madein order to enhance the half-life of the peptide (see G. Pasuta and F.M. Veronese (2007) “Polymer-drug conjugation, recent achievements andgeneral strategies” Progress in Polymer Science 32 (8-9): 933-961).

Combination Therapy

The polypeptides and nucleic acids encoding polypeptides compositionsand methods of the present invention may be used for treatment of any ofthe foregoing diseases, indications, conditions or syndromes, or anydisease, indication, condition or syndrome by administration incombination with one or more other pharmaceutically active compounds.Such combination administration may be by means of a single dosage formwhich includes both a peptide of the present invention and one moreother pharmaceutically active compound, such single dosage formincluding a tablet, capsule, spray, inhalation powder, injectable liquidor the like. Alternatively, combination administration may be by meansof administration of two different dosage forms, with one dosage formcontaining a peptide of the present invention, and the other dosage formincluding another pharmaceutically active compound. In this instance,the dosage forms may be the same or different. Without meaning to limitcombination therapies, the following exemplifies certain combinationtherapies which may be employed.

According to an additional further aspect of the present invention thereis provided a combination treatment comprising the administration of apharmacologically effective amount of a compound according to theinvention, optionally together with a pharmaceutically acceptablecarrier, with the simultaneous, sequential or separate administration ofat least one pharmacologically active agent (s) that is (are) useful inthe treatment of various weight and feeding-related disorders, such asobesity and/or overweight.

Thus, polypeptides and nucleic acids encoding polypeptides of theinvention may be combined with one or more other pharmacologicallyactive agent (s) that is (are) useful in the treatment of various weightand feeding-related disorders, such as obesity and/or overweight, inparticular other anti-obesity drugs that affect energy expenditure,glycolysis, gluconeogenesis, glucogenolysis, lipolysis, lipogenesis, fatabsorption, fat storage, fat excretion, hunger and/or satiety and/orcraving mechanisms, appetite/motivation, food intake, orgastrointestinal motility. Drugs that reduce energy intake include, inpart, various pharmacological agents, referred to as anorectic drugs,which are used as adjuncts to behavioural therapy in weight reductionprograms.

Generally, a total dosage of the below-described obesity control agentsor medications, when used in combination with one or more peptides ornucleic acids of the present invention can range from 0.1 to 3,000mg/day, preferably from about 1 to 1,000 mg/day and more preferably fromabout 1 to 200 mg/day in single or 2-4 divided doses. The exact dose,however, is determined by the attending clinician and is dependent onsuch factors as the potency of the compound administered, the age,weight, condition and response of the patient.

Polypeptides and nucleic acids of the invention may be combined with oneor more other pharmacologically active agent (s) that is (are) useful inthe treatment of diabetes, such as other anti-diabetic drugs.

Polypeptides and nucleic acids of the invention may in addition oralternatively further be combined with one or more otherpharmacologically active agent(s) that is (are) useful in the treatmentof diseases, disorders and/or conditions associated with obesity and/oroverweight, such as insulin resistance; impaired glucose tolerance; type2 diabetes; metabolic syndrome; dyslipidemia (including hyperlipidemia);hypertension; heart disorders (e.g. coronary heart disease, myocardialinfarction); cardiovascular disorders; non-alcoholic fatty liver disease(including non-alcoholic steatohepatitis); joint disorders (includingsecondary osteoarthritis); gastroesophageal reflux; sleep apnea;atherosclerosis; stroke; macro and micro vascular diseases; steatosis(e.g. in the liver); gall stones; and gallbladder disorders.

In embodiments, polypeptides and nucleic acids of the invention may beprovided for cosmetic purposes to decrease aesthetic dissatisfaction oranother cosmetic condition. A cosmetic condition refers to a conditiondue to normal processes in the body, for example aging, pregnancy,puberty. For example polypeptides and nucleic acids of the invention maybe provided to reduce deposits of fat on the face, periorbital area,cheeks, chin, neck, chest, breast, abdomen, buttocks, hips, thighs, legsor arms or combinations thereof. In embodiments, this treatment mayimprove reduced self-esteem and psychosocial distress.

According to a further aspect of the invention there is provided acombination treatment comprising the administration of apharmacologically effective amount of a peptide and nucleic acidsaccording to the invention, or a pharmaceutically acceptable saltthereof, optionally together with a pharmaceutically acceptable diluentor carrier, with the simultaneous, sequential or separate administrationof one or more of the following agents selected from: (1) insulin andinsulin analogues; (2) insulin secretagogues, including sulphonylureas(e.g. glipizide) and prandial glucose regulators (sometimes called“short-acting secretagogues”), such as meglitinides (e.g. repaglinideand nateglinide); (3) agents that improve incretin action, for exampledipeptidyl peptidase IV (DPP-4) inhibitors (e.g. vildagliptin,saxagliptin, and sitagliptin), and glucagon-like peptide-1 (GLP-1)agonists (e.g. exenatide); (4) insulin sensitising agents includingperoxisome proliferator activated receptor gamma (PPARy) agonists, suchas thiazolidinediones (e.g. pioglitazone and rosiglitazone), and agentswith any combination of PPAR alpha, gamma and delta activity; (5) agentsthat modulate hepatic glucose balance, for example biguanides (e.g.metformin), fructose 1,6-bisphosphatase inhibitors, glycogenphopsphorylase inhibitors, glycogen synthase kinase inhibitors, andglucokinase activators; (6) agents designed to reduce/slow theabsorption of glucose from the intestine, such as alpha-glucosidaseinhibitors (e.g. miglitol and acarbose); and (7) agents which antagonisethe actions of or reduce secretion of glucagon, such as amylin analogues(e.g. pramlintide); (8) agents that prevent the reabsorption of glucoseby the kidney, such as sodium-dependent glucose transporter 2 (SGLT-2)inhibitors (e.g. dapagliflozin); (9) agents designed to treat thecomplications of prolonged hyperglycaemia, such as aldose reductaseinhibitors (e.g. epalrestat and ranirestat); and agents used to treatcomplications related to micro-angiopathies; (10) anti-dyslipidemiaagents, such as HMG-CoA reductase inhibitors (statins, e.g.rosuvastatin) and other cholesterol-lowering agents; PPARa agonists(fibrates, e.g. gemfibrozil and fenofibrate); bile acid sequestrants(e.g. cholestyramine); (11) cholesterol absorption inhibitors (e.g.plant sterols (i.e. phytosterols), synthetic inhibitors); cholesterylester transfer protein (CETP) inhibitors; inhibitors of the ilea) bileacid transport system (I BAT inhibitors); bile acid binding resins;nicotinic acid (niacin) and analogues thereof; anti-oxidants, such asprobucol; and omega-3 fatty acids; (12) antihypertensive agents,including adrenergic receptor antagonists, such as beta blockers (e.g.atenolol), alpha blockers (e.g. doxazosin), and mixed alpha/betablockers (e.g. labetalol); adrenergic receptor agonists, includingalpha-2 agonists (e.g. clonidine); angiotensin converting enzyme (ACE)inhibitors (e.g. lisinopril), calcium channel blockers, such asdihydropyridines (e.g. nifedipine), phenylalkylamines (e.g. verapamil),and benzothiazepines (e.g. diltiazem); angiotensin 11 receptorantagonists (e.g. candesartan); aldosterone receptor antagonists (e.g.eplerenone); centrally acting adrenergic drugs, such as central alphaagonists (e.g. clonidine); and diuretic agents (e.g. furosemide); (13)haemostasis modulators, including antithrombotics, such as activators offibrinolysis; thrombin antagonists; factor Vila inhibitors;anticoagulants, such as vitamin K antagonists (e.g. warfarin), heparinand low molecular weight analogues thereof, factor Xa inhibitors, anddirect thrombin inhibitors (e.g. argatroban); antiplatelet agents, suchas cyclooxygenase inhibitors (e.g. aspirin), adenosine diphosphate (ADP)receptor inhibitors (e.g. clopidogrel), phosphodiesterase inhibitors(e.g. cilostazol), glycoprotein IIB/IIA inhibitors (e.g. tirofiban), andadenosine reuptake inhibitors (e.g. dipyridamole); (14) anti-obesityagents, such as appetite suppressant (e.g. ephedrine), includingnoradrenergic agents (e.g. phentermine) and serotonergic agents (e.g.sibutramine), pancreatic lipase inhibitors (e.g. orlistat), microsomaltransfer protein (MTP) modulators, diacyl glycerolacyltransferase (DGAT)inhibitors, and cannabinoid (CBI ) receptor antagonists (e.g.rimonabant); (15) feeding behavior modifying agents, such as orexinreceptor modulators and melanin-concentrating hormone (MCH) modulators;(16) glucagon like peptide-1 (GLP-1) receptor modulators; (17)neuropeptideY (NPY)/NPY receptor modulators; (18) pyruvate dehydrogenasekinase (PDK) modulators; (19) serotonin receptor modulators; (20)leptin/leptin receptor modulators; (21) ghrelin/ghrelin receptormodulators; or (22) monoamine transmission-modulating agents, such asselective serotonin reuptake inhibitors (SSRI) (e.g. fluoxetine),noradrenaline reuptake inhibitors (NARI), noradrenaline-serotoninreuptake inhibitors (SNRI), triple monoamine reuptake blockers (e.g.tesofensine), and monoamine oxidase inhibitors (MAOI) (e.g. toloxatoneand amiflamine), or a pharmaceutically acceptable salt, solvate, solvateof such a salt or a prodrug thereof, optionally together with apharmaceutically acceptable carrier to a mammal, such as man, in need ofsuch therapeutic treatment.

According to an additional further aspect of the present invention thereis provided a combination treatment comprising the administration of apharmacologically effective amount of a compound according to theinvention, or a pharmaceutically acceptable salt thereof, optionallytogether with a pharmaceutically acceptable carrier, with thesimultaneous, sequential or separate administration of very low caloriediets (VLCD) or low-calorie diets (LCD).

According to a further aspect of the present invention there is provideda kit comprising FKBP-L polypeptide, a biologically active fragment ofan FKBP-L polypeptide, a derivative of FKBP-L polypeptide, or aderivative of a biologically active fragment of an FKBP-L polypeptidethereof, or a nucleic acid sequence encoding FKBP-L and instructions foruse of the same to reduce obesity or obesity related diseases or forcosmetic purposes. Optionally, the kit can comprise one or more of thefollowing agents selected from: (1) insulin and insulin analogues; (2)insulin secretagogues, including sulphonylureas (e.g. glipizide) andprandial glucose regulators (sometimes called “short-actingsecretagogues”), such as meglitinides (e.g. repaglinide andnateglinide); (3) agents that improve incretin action, for exampledipeptidyl peptidase IV (DPP-4) inhibitors (e.g. vildagliptin,saxagliptin, and sitagliptin), and glucagon-like peptide-1 (GLP-1)agonists (e.g. exenatide); (4) insulin sensitising agents includingperoxisome proliferator activated receptor gamma (PPARy) agonists, suchas thiazolidinediones (e.g. pioglitazone and rosiglitazone), and agentswith any combination of PPAR alpha, gamma and delta activity; (5) agentsthat modulate hepatic glucose balance, for example biguanides (e.g.metformin), fructose 1,6-bisphosphatase inhibitors, glycogenphopsphorylase inhibitors, glycogen synthase kinase inhibitors, andglucokinase activators; (6) agents designed to reduce/slow theabsorption of glucose from the intestine, such as alpha-glucosidaseinhibitors (e.g. miglitol and acarbose); and (7) agents which antagonisethe actions of or reduce secretion of glucagon, such as amylin analogues(e.g. pramlintide); (8) agents that prevent the reabsorption of glucoseby the kidney, such as sodium-dependent glucose transporter 2 (SGLT-2)inhibitors (e.g. dapagliflozin); (9) agents designed to treat thecomplications of prolonged hyperglycaemia, such as aldose reductaseinhibitors (e.g. epalrestat and ranirestat); and agents used to treatcomplications related to micro-angiopathies; (10) anti-dyslipidemiaagents, such as HMG-CoA reductase inhibitors (statins, e.g.rosuvastatin) and other cholesterol-lowering agents; PPARa agonists(fibrates, e.g. gemfibrozil and fenofibrate); bile acid sequestrants(e.g. cholestyramine); (11) cholesterol absorption inhibitors (e.g.plant sterols (i.e. phytosterols), synthetic inhibitors); cholesterylester transfer protein (CETP) inhibitors; inhibitors of the ilea) bileacid transport system (I BAT inhibitors); bile acid binding resins;nicotinic acid (niacin) and analogues thereof; anti-oxidants, such asprobucol; and omega-3 fatty acids; (12) antihypertensive agents,including adrenergic receptor antagonists, such as beta blockers (e.g.atenolol), alpha blockers (e.g. doxazosin), and mixed alpha/betablockers (e.g. labetalol); adrenergic receptor agonists, includingalpha-2 agonists (e.g. clonidine); angiotensin converting enzyme (ACE)inhibitors (e.g. lisinopril), calcium channel blockers, such asdihydropyridines (e.g. nifedipine), phenylalkylamines (e.g. verapamil),and benzothiazepines (e.g. diltiazem); angiotensin II receptorantagonists (e.g. candesartan); aldosterone receptor antagonists (e.g.eplerenone); centrally acting adrenergic drugs, such as central alphaagonists (e.g. clonidine); and diuretic agents (e.g. furosemide); (13)haemostasis modulators, including antithrombotics, such as activators offibrinolysis; thrombin antagonists; factor Vila inhibitors;anticoagulants, such as vitamin K antagonists (e.g. warfarin), heparinand low molecular weight analogues thereof, factor Xa inhibitors, anddirect thrombin inhibitors (e.g. argatroban); antiplatelet agents, suchas cyclooxygenase inhibitors (e.g. aspirin), adenosine diphosphate (ADP)receptor inhibitors (e.g. clopidogrel), phosphodiesterase inhibitors(e.g. cilostazol), glycoprotein IIB/IIA inhibitors (e.g. tirofiban), andadenosine reuptake inhibitors (e.g. dipyridamole); (14) anti-obesityagents, such as appetite suppressant (e.g. ephedrine), includingnoradrenergic agents (e.g. phentermine) and serotonergic agents (e.g.sibutramine), pancreatic lipase inhibitors (e.g. orlistat), microsomaltransfer protein (MTP) modulators, diacyl glycerolacyltransferase (DGAT)inhibitors, and cannabinoid (CBI ) receptor antagonists (e.g.rimonabant); (15) feeding behavior modifying agents, such as orexinreceptor modulators and melanin-concentrating hormone (MCH) modulators;(16) glucagon like peptide-1 (GLP-1) receptor modulators; (17)neuropeptideY (NPY)/NPY receptor modulators; (18) pyruvate dehydrogenasekinase (PDK) modulators; (19) serotonin receptor modulators; (20)leptin/leptin receptor modulators; (21) ghrelin/ghrelin receptormodulators; or (22) monoamine transmission-modulating agents, such asselective serotonin reuptake inhibitors (SSRI) (e.g. fluoxetine),noradrenaline reuptake inhibitors (NARI), noradrenaline-serotoninreuptake inhibitors (SNRI), triple monoamine reuptake blockers (e.g.tesofensine), and monoamine oxidase inhibitors (MAOI) (e.g. toloxatoneand amiflamine), or a pharmaceutically acceptable salt, solvate, solvateof such a salt or a prodrug thereof.

In a further aspect of the invention there is provided the use of FKBP-Lpolypeptides and nucleic acid sequences encoding the same as a biomarkerfor obesity and obesity-related disorders. This could be measured byassessing the expression levels of FKBP-L in blood/tissue samples byELISA/IHC; low FKBP-L expression levels would be associated withobesity. Alternatively, levels of mRNA encoding FKBP-L could bemeasured. In further alternative methods SNPs of FKBP-L could bedetermined and used to measure expected expression or activity ofFKBP-L. This would allow subjects with decreased levels of expression oractivity of FKBP-L to be selected for treatment with FKBP-L polypeptidesor nucleic acids as discussed herein.

Suitably low expression levels of FKBP-L may be levels which provide 50%of FKBP-L levels relative to a control/normal sample. For example,typically FKBP-L may be about 1.423 ng/ml (+/−±0.1694SD) in controlsubjects. Suitably a value of less than 0.9 ng/ml, in particular lessthan 0.66 ng/ml may be considered as ‘low’ or ‘reduced’. Suitably a lowlevel of FKBP-L may be assessed in serum by ELISA (as discussed in FIGS.14 and 15) or is tissues using immunohistochemical staining wherein thedifferences in intensity in the signal obtained can be assigned valuessuch as high, medium and low.

Accordingly, there is provided a method of identifying patients withmutation of the FKBP-L gene or regulatory sequences which result indecreased expression of FKBP-L or results in expression of a less activeform of FKBP-L. Likewise, mutations will be detected in blood samplesusing direct sequencing or allele-specific qPCR using primers designedto detect specific mutations associated with obesity.

Assessing the expression levels of FKBP-L in blood/tissue samples can beby determining an interaction between two agents for example determiningwhether an interaction between two proteins or two nucleic acids ispresent or absent. For example, the interaction of FKBP-L with anantibody specific for FKBP-L; or FKBP-L mRNA with a nucleic acid probespecific for the FKBP-L gene.

Detection may include quantification. Detection may include the use ofan agent which is capable of detection (a label) using for examplespectrophotometry, flow cytometry, or microscopy. Exemplary labelsinclude radioactive isotopes (such as ³H, ¹⁴C, ¹⁵N, ³⁵S, ⁹⁰V, ⁹⁹Tc, ¹¹¹Ln, ¹²⁵I, or ¹³¹ I), fluorophores (such as fluorescein, fluoresceinisothiocyanate, rhodamine or the like), chromophores, ligands,chemiluminescent agents, bioluminescent agents (such as luciferase,green fluorescent protein (GFP) or yellow fluorescent protein), enzymesthat can produce a detectable reaction product (such as horseradishperoxidise, luciferase, alkaline phosphatase, beta-galactosidase) andcombinations thereof. An example of an antibody which specifically bindsFKBP-L is the FKBP-L rabbit polyclonal primary antibody (ProteinTech IL,USA, Cat no. 10060-1-AP). To detect this primary antibody, ananti-rabbit IgG horseradish peroxidase secondary antibody (GEHealthcare, Cat no. NA934V) may be used.

Preferred features and embodiments of each aspect of the invention areas for each of the other aspects mutatis mutandis unless context demandsotherwise.

Each document, reference, patent application or patent cited in thistext is expressly incorporated herein in their entirety by reference,which means it should be read and considered by the reader as part ofthis text. That the document, reference, patent application or patentcited in the text is not repeated in this text is merely for reasons ofconciseness.

Reference to cited material or information contained in the text shouldnot be understood as a concession that the material or information waspart of the common general knowledge or was known in any country.

As used herein, the articles “a” and “an” refer to one or to more thanone (for example to at least one) of the grammatical object of thearticle.

“About” shall generally mean an acceptable degree of error for thequantity measured given the nature or precision of the measurements.

Throughout the specification, unless the context demands otherwise, theterms ‘comprise’ or ‘include’, or variations such as ‘comprises’ or‘comprising’, ‘includes’ or ‘including’ will be understood to imply theincludes of a stated integer or group of integers, but not the exclusionof any other integer or group of integers.

The present invention is further illustrated by the accompanyingExamples which do not limit the scope of the invention.

EXAMPLES

The activity of the polypeptides and nucleic acids according to theinvention was assessed in following experiments to determine their useas anti-obesity agents. The importance of FKBP-L levels throughgeneration of FKBP-L deficient mice, and FKBP-L in obese patient serum,also highlight how a deficiency in FKBP-L levels or function could beused as biomarkers of obesity or obesity-related disorders.

Example 1

Comparison of Weight Gain and Increased Adiposity in Fkbpl+/− Mice withtheir Wild-Type (WT) Littermates, Fkbpl+/+ on a Normal and on a High FatDiet.

To generate FKBP-L+/− mice, C57BL/6N mice were used for microinjectionof the Fkbpl-targeted embryonic stem cell line, JM8A3. The vector, EScell(s), and/or mouse strain used was generated by the trans-NIHKnock-Out Mouse Project (KOMP) and obtained from the KOMP Repository(www.komp.org). ES cells were obtained from KOMP (USA); exon 2 of Fkbplwas deleted. (Fkbpl—IKMC Project: 41363; Clone number: EPD0466_1_C01),obtained from KOMP (UC Davis Repository, USA) were microinjected at MRCHarwell (UK) into C57BL/6N mice mouse blastocysts to establish germ-linetransmission. The resulting chimeric offspring were bred with C57BL miceto obtain germline transmission of the mutated Fkbpl allele and obtainFkbpl+/ neo mice. Subsequently, Fkbpl+/ neo mice were crossed withB6N-TgN (ACTB-Cre)3Mrt/H mice (βactin-Cre Tg) to ubiquitously remove thefloxed neomycin selective marker from the Fkbpl mutated allele(Fkbpl+/). Fkbpl+/− mice were further bred to remove the β-actin-Crefrom the germline. The resulting Fkbpl+/− was used in comparison totheir Fkbpl+/+ littermates in all further analyses.

and Fkbpl^(+/+) mice from the Fkbpl transgenic strain developed, werehoused in open top boxes. Up to four mice were housed per box to avoidstress. Mouse were fed a normal chow diet and allowed to age.Fkbpl^(+/−) mice (n=27) began to develop obesity compared to Fkbpl^(+/+)mice (n=20) between age 2-6 months old on this normal diet, asillustrated in FIGS. 1A and 1B. In a separate study, where mice wereindividually caged to measure food intake, results suggest that foodintake was similar in Fkbpl^(+/−) and Fkbpl^(+/+) mice was similar asprovided in FIG. 3.

For the high fat diet study 10 mice per group were used. All mice wereweighed at experimental start date, biweekly for the first three weeksto ensure health, and weekly thereafter. Mice were solely fed a high fatdiet comprising 60% fat (Cat no. F3282, Dates and, USA). Food providedwas weighed biweekly for three weeks, then weekly, to ensure equal foodprovisions between boxes, with an allowance of 5 g per mouse per dayassumed.

After feeding a high fat diet, mice developed obesity between 3-10 weeksas shown in FIG. 1C, however Fkbpl^(+/−) mice gained significantly moreweight than Fkbpl^(+/+) littermates.

Fkbpl^(+/−) mice also had increased adiposity associated with theirweight gain (FIG. 2A, B) and demonstrate a significant increase in thenumber and size of adipocytes (FIG. 2C). It is important to note thatobese individuals tend to have more adipocytes (hyperplasia) which arelarger in size (hypertrophy). These adipocytes were successfullycharacterised using the adipocyte specific stain, Nile Red (FIG. 2c ).We were also able to purify more adipocyte stem cells (ASCs) from thefat tissue of Fkbpl^(+/−) mice compared to Fkbpl^(+/+) mice (FIG. 2D).

The above results indicate that a deficiency in FKBP-L is associatedwith adipogenesis, overweight and obesity.

Example 2

Oral Glucose Tolerance Test (OGTT)

An OGTT was performed by fasting the mice for 4 h, taking baseline bloodglucose, administering 40% D-glucose, and recording two further bloodglucose readings at 30 and 60 min. As illustrated in FIG. 1D,Fkbpl^(+/−) mice has demonstrated a reduced glucose tolerance comparedto wild-type Fkbpl^(+/+) mice.

The results of this experiment indicate that a deficiency in FKBP-L isassociated with the development of diabetes mellitus type 2.

Example 3

Weight Gain and Glucose Intolerance Improved Following Administration ofFKBP-L's Peptide Derivative ALM201

For the high fat diet study, 40 age and sex matched mice were chosenwith an age range of 6-10 weeks at the experimental start date. Micewere randomised into four groups: PBS Fkbpl^(+/−), PBS Fkbpl^(+/+),ALM201 Fkbpl^(+/−) and ALM201 Fkbpl^(+/+). Power calculations wereutilised to predict the number of mice needed to show statisticalsignificance. Taking group 1 mean weight to be 25 g and group 2 meanweight to be 45 g, with a standard deviation of 13 gives a sample sizeof eight mice per group when powered to 0.8, with α=0.05. 10 mice pertreatment group were used. All mice were weighed at experimental startdate, biweekly for the first three weeks to ensure health, and weeklythereafter. Mice were solely fed a high fat diet comprising 60% fat (Catno. F3282, Dates and, USA). Food provided was weighed biweekly for threeweeks, then weekly, to ensure equal food provisions between boxes, withan allowance of 5 g per mouse per day assumed. ALM201 was reconstitutedin PBS, stored at −20° C. , and injected subcutaneously at a dose of 0.3mg/kg, 5 days per week. Mice in the control group were injected with acomparable volume of PBS, 5 days per week.

As shown in FIGS. 4 and 5, the weight gain and glucose intolerance inFkbpl+/− mice fed a high fat diet was significantly reduced followingsupplementation with ALM201. ALM201 also partially prevented weight gainin wild-type mice.

These data indicate that a pharmacologically-based increase in FKBP-Lcould potentially be protective in development of obesity and glucoseintolerance.

Example 4

Regulation of the Obesity Protein, SIRT1 (mRNA and Protein) by FKBP-L

For mRNA from mouse tissues: Mouse organs from Fkbpl^(+/+) andFkbpl^(+/−) mice were excised (pooled from three mice), stored inRNAlater solution (Life Technologies, UK) at −80° C., and then processedfor qRT-PCR. In brief, samples were thawed immediately before use, and30 mg of lung, liver, and kidney, and 20 mg of spleen was added to lysisbuffer from the GeneJET RNA Purification Kit (ThermoScientific, UK) inGentleMACS M tubes (Miltenyi Biotec, UK) and tissues disrupted using theRNA program on the GentleMACS Tissue Dissociator (Miltenyi Biotec, UK).Dissociated tissue was then processed as per the manufacturer's protocolin the GeneJET RNA Purification Kit (ThermoScientific, UK). RNA puritywas confirmed using the NanoDrop Spectrophotometer (2000c, ThermoScientific), where 260/280 should be 2.0, and 260/230 should be 2.0-2.2.RNA samples were stored at −80° C. cDNA was prepared from 1 μg ofextracted RNA using the Roche first strand cDNA synthesis kit (Roche,UK) following the manufacturer's protocol. cDNA was prepared forquantitative realtime polymerase chain reaction (qRT-PCR) using theRoche Lightcycler Probes 480 Mastermix kit (Roche, UK) and AppliedBiosystems TaqMan Gene expression assays for murine Fkbpl(Mm00498192_s1)and Gapdh (Mm99999915_g 1) (Applied Biosystems) or Roche Realtime ReadyTaqMan gene expression mono hydrolysis Probes for Sirt1 (assay ID310480, config. No 100052233) (Roche, UK) to amplify the previouslyobtained cDNA on the LightCycler 480 qRT-PCR machine (Roche, UK). 2 μLcDNA was added to 5 μL Mastermix, along with 2 μL water, and 1 μL of therelevant TaqMan probe mix. Samples containing either no DNA or noreverse transcriptase (RT) mix were also prepared as negative controlsfor the PCR reaction. A standard curve was determined for each probe andused to determine the efficiency of each PCR reaction. PCR reactionswere set up in a 96 well plate (Roche, UK), sealed with a microsealadhesive film (Roche, UK), and loaded into the LightCycler device.Samples were denatured at 95° C. for 10 min and subjected to 45 cyclesof denaturing at 95° C. for 10 sec, annealing at 60° C. for 30 sec and72° C. for 10 sec. Fluorescence was measured every cycle. The resultingcrossing points (Cp—first cycle where a sample shows logarithmicamplification) were calculated using the Roche LightCycler 480 software,and quantified using the standard curve efficiency. Cp values less than32 indicated sufficient RNA expression to quantify differencesaccurately. Sample Cp values were corrected to sample Gapdh Cp values.

FIG. 6 A shows a significant reduction in SIRT1 mRNA levels in Fkbpl+/−mice compared to Fkbpl+/+ mice across a range of tissues.

For assessing protein levels: Cell lysates were prepared in RIPA bufferfrom MDA-MB-231, A3, MCF-7 and D2 cells and subjected to WesternBlotting. The membrane was then probed with a 1:1000 dilution of rabbitFKBP-L IgG polyclonal primary antibody (Proteintech UK, cat:10060-1-AP), 1:1000 rabbit SIRT1 IgG monoclonal primary antibody (Abcam,UK cat: ab32441) in 3% blocking solution overnight on a rocker at 4° C.The membrane was washed with PBS-Tween and then PBS for 5 min each, andwas probed for an hour with a 1:5000 dilution of ECL anti rabbit IgG HRPlinked whole secondary antibody (GE Healthcare UK Ltd.) Membranes werewashed and developed as in section 2.2.2.11.3. Membranes were thenstripped with Restore™ Western Blot Stripping Buffer (Thermo Scientific)for 10 min, washed, re-probed with rabbit GAPDH primary antibody(Sigma-Aldrich), and a 1:5000 dilution of ECL anti rabbit IgG HRP linkedwhole secondary antibody (GE Healthcare UK Ltd.) and developed as above.SIRT1 was identified as a band around 110 kDa, FKBP-L at 42 kDa.

For FKBP-L siRNA-mediated knockdown: 2×10⁶ MDA-MB-231 cells supplementedwith complete media were seeded into a 90 mm plate (Nunc, UK) and leftto adhere for 24 h prior to transfection. Complete media was aspiratedand 5 mL of Opti-MEM media (Gibco, UK) was added to each well for 2 h.Cells were then transfected with FKBP-L siRNA (Invitrogen, UK). siFKBP-L(Invitrogen, UK) was supplied at a 20 nM concentration, and comes asthree siRNA;

F1 (SEQ ID NO: 41) (GGAGACGCCACCAGUCAAUACAAUU), F2 (SEQ ID NO: 42)(GCUGAACUUGAAGGAGACUCUCAUA), and F3 (SEQ ID NO: 43)(CAGCCAAAUUCUAGAGCAUACUCAA).

These are designed to be used together to achieve transient knockdown.Cells were transfected using Oligofectamine™, with tubes A and B set upfor each condition. 15 μL of each siRNA was added to Tube A, and wasdiluted with 746 μL Opti-MEM per sample. In tube B, 28 μLOligofectamine™ was diluted to 111.96 μl with Opti-MEM per sample. Tubeswere left to incubate at room temperature for 5 min, and were thencombined and incubated at room temperature for 20 min before addition ofthe 900 μL total to the appropriate plate. Cells were incubated withtransfection mix for 4 h at 37° C., and then incubated with mediacontaining 30% FCS for 72 h.

A non-targeting siRNA (Invitrogen, UK) was also prepared at the sameconcentration and added to a separate plate as a control, as well as anuntreated plate with no transfection agent added. Cell lystates werestored in RNAlater solution (Life Technologies, UK) at −80° C., and thenprocessed for qRT-PCR to assess SIRT1 levels as described previously.

FKBP-L overexpression in A3 and D2 cells was associated with increasedSIRT1 mRNA and protein levels (FIG. 6B), whilst FKBP-L knockdown led toa reduction in SIRT1 mRNA (FIG. 6C).

These data indicate that the reduction in SIRT1 levels in the obeseFkbpl^(+/−) mice, might be partially responsible for the increasedweight gain and adiposity. Importantly, FKBP-L's peptide derivative,ALM201 (SEQ ID NO:10), increased SIRT1 levels as shown in FIG. 6D.

Example 5

Evidence that ALM201 Modifies Cytokine Release Associated with Obesity:

Data provided in FIG. 7 demonstrate that FKBP-L's therapeutic peptide,ALM201, can reduce secreted leptin, TIMP1 and IL-8 levels, such levelsare known to be increased in obesity. A Ray Biotech cytokine array wasused to measure cytokines in the spent medium of MDA231 cells afterexposure to ALM201. Blots were then quantitated by densitometricanalysis using Ray Biotech software. IL8 and TIMP1 levels were thenvalidated by ELISA in two or three independent repeats. A reduction inthese cytokines would reduce the obesity phenotype.

Example 6

Evidence that FKBP-L/AD-01 can Reduce Proinflammatory ResponsesAssociated with Obesity

Impaired local proinflammatory response in the adipocyte leads toincreased ectopic lipid accumulation, glucose intolerance, and systemicinflammation. Adipocyte hypertrophy and hypoxia provide idealenvironments for the development of adipose tissue inflammation, bypromoting the influx of macrophages and other immune cells. Dataprovided in FIG. 12 show that FKBP-L fragments, AD-01 (24 as peptide),can inhibit lipopoylsaccaride induced NFkB signalling in the THP1monocyte (macrophage) cell line and this results in a dramatic reductionin the pro-inflammatory cytokine IL-1β secretion in obesity as observedin FIG. 13.

THP1 cells were treated with 100 ng/ml LPS and cell lysates harvestedand subjected to western blotting as described in Example 4, usingprimary antibody against pSER36 NFkB (at a 1:1000 dilution) and a 1:5000dilution of ECL anti rabbit IgG HRP linked whole secondary antibody (GEHealthcare UK Ltd.). To measure IL-1β levels THP1 cells were treatedwith 1000 ng/ml LPS±AD-01 and conditioned cell culture medium wascollected 24 h later and assessed using an IL-1β ELISA.

Macrophages within the adipose tissue are polarized to the M1inflammatory phenotype, producing this proinflammatory cytokine. Theinventors therefore consider endogenous FKBP-L and its therapeuticpeptides may be protective of obesity through abrogation of inflammatorysignalling in both adipocytes and macrophages.

Example 7

FKBP-L Controls the Adipogenic Process Associated with Obesity

FIG. 2C demonstrates a significant increase in the number and size ofadipocytes in Fkbpl^(+/−) mice compared to wildtype Fkbpl^(+/+) mice. Itwas possible to purify more adipocyte stem cells (ASCs) from the fattissue of Fkbpl^(+/−) mice compared to Fkbpl^(+/+) mice (FIG. 2D). It isimportant to note that obese individuals tend to have more adipocytes(hyperplasia) which are larger in size (hypertrophy). Subcutaneousadipose tissue from Fkbpl^(+/−) mice also demonstrated hypertrophicadipcocytes (FIG. 10). Hypertrophy is considered to be the maincontributor to adipose tissue enlargement and is associated withabnormal adipocyte function leading to impaired insulin sensitivity. Adeficiency in FKBP-L may therefore drive adipose tissue hypertrophywhich leads to development of obesity in Fkbpl deficient mice. In vitroexperiments in FIG. 11 support this where it was shown that FKBP-L mRNAlevels are naturally increased during adipogenesis. If levels of FKBP-Lwere low then adipogenesis would be abrogated leading to hypertrophicadipocytes. This offers a mechanism by which FKBP-L may protect againstobesity.

Example 8

FKBP-L (Nucleotides) Gene Therapy can Reduce Obesity in Mice on a Normaland High Fat Diet.

Male C57BL/6N mice at 8 weeks old were fed either HFD or standard chow,and randomised into three groups: no treatment (control; n=4), or weeklyIV pFKBPL (n=5) or IV RALA-pFKBPL (n=5 and 4, respectively). The micewere then either fed a HFD comprising 60% fat (Cat no. F3282, Dates and,USA) for 4 weeks or normal chow and injected once a week with eitherpFKBPL (20 μg) or RALA-pFKBPL (20 μg). All mice were weighed atexperimental start date and, weekly for four weeks to ensure health.Food provided was weighed to ensure equal food provisions between boxes,in a separate experiment, to assess difference in food intake, with anallowance of 5 g per mouse per day assumed. No significant changes infood intake were observed between experimental groups.

In another study, male C57BL/6N mice at 8 weeks old were fed either HFDor standard chow, and randomised into three groups: no treatment(control; n=3 and 4, respectively) or weekly IV pFKBPL (n=4 and 5,respectively) or IV RALA-pFKBPL (n=4 and 6, respectively). The mice werethen either fed a HFD comprising 60% fat (Cat no. F3282, Dates and, USA)for 14 weeks or normal chow. After 14 weeks of feeding mice wereinjected once a week, for 3 weeks, with either pFKBPL (20 μg) orRALA-pFKBPL (20 μg), whilst maintaining their diet. All mice wereweighed at experimental start date, weekly for the duration. Foodprovided was weighed to ensure equal food provisions between boxes, in aseparate experiment, to assess difference in food intake, with anallowance of 5 g per mouse per day assumed. No significant changes infood intake were observed between experimental groups.

pFKBPL plasmid was made from MAX Efficiency DH5α-competent cellscontaining relevant plasmids (pFKBPL) cultured in a shaking incubatorovernight at 37° C. in Luria broth containing the appropriateantibiotic. Plasmid DNA was isolated and purified using PureLink HiPurePlasmid Maxiprep Kits (Life Technologies) using the manufacturer'sprotocol. Plasmid DNA was dissolved in ultrapure water and stored at−20° C.

For RALA-pFKBPL, the RALA peptide was custom-synthesized usingsolid-state synthesis (fluorenylmethyloxycarbonyl [FMOC]) (Biomatik) andsupplied as a desalted lyophilized powder. Reconstitution was inultrapure water to a stock concentration of 11.6 mg/mL. Aliquots werestored at −20° C. until use.

pFKBPL/RALA nanocomplexes were constructed. Briefly, plasmid DNA wasmixed with RALA immediately prior to injection, to facilitateelectrostatic interaction of the anionic DNA with the cationic peptide.Nanoparticles were complexed at N:P10 (the N:P ratio is the molar ratioof positively charged nitrogen atoms in the peptide to negativelycharged phosphates in the pDNA backbone—at N:P10, 290 μg of RALA is usedto neutralize 20 μg of DNA). Nanoparticles were previously analyzed interms of their hydrodynamic size and particle charge using a Nano ZSZetasizer and DTS software (Malvern Instruments).

As shown in FIG. 16, the weight gain of mice increased on normal chow,but weight gain was significantly higher on a HFD. Notably, pFKBPL genetherapy significantly reversed weight gain on a HFD and a normal diet;the latter is very impressive as these mice were a normal weight.Finally, delivery of the gene therapy using the delivery peptide RALA(RALA-pFKBPL) significantly improved efficacy. In FIG. 17, where micewere fed a HFD or normal diet for 14 weeks and where HFD mice whereseverely obese before receiving any treatment, both pFKBPL andRALA-pFKBPL were able to reverse weight gain significantly; again thedelivery peptide RALA improved efficacy. This data strongly suggest thatan FKBP-L-based gene therapy can be used in obese individuals to reduceweight or could be used to prevent weight gain in individuals who aresusceptible to obesity. There was a 50% decrease in weight gainfollowing treatment with RALA-pFKBPL (this equates to a 5% decrease intotal body weight compared to controls—FIG. 18). This is highlysignificant since the primary efficacy endpoint for weight lossmedicines stipulated by the European Medicines Agency is 5-10%. Thiscould be further optimised by more frequent agent administration and ahigher dosage.

Example 9: Use of FKBP-L as a Biomarker of Obesity

FKBP-L levels predict obesity in mice (FIG. 1). Serum FKBP-L levels inobese (n=50) vs lean (n=30) children, aged 7-18 years, were assessed.Serum FKBP-L concentration was assessed by ELISA (Cloud Clone, USA).Serum samples, collected from lean and obese study participants werediluted 1:1 with standard diluent. Standards were prepared using thestandard diluent with final concentrations in the range 0.156 ng/mL to10 ng/mL. Standards and diluted serum samples were pipetted into wells(100 μL per well) on the pre-coated ELISA plate and incubated at 37° C.for 2 h. Standards and samples were then removed from each well and 1004of Detection Reagent A was added to each well, without washing. TheELISA plate was then incubated for 1 h at 37° C. Detection Reagent A wasthen removed and wells were washed three times with 300 μL of 1× WashBuffer. 1004 of Detection Reagent B was then added to each well, andincubated for 1 h at 37° C. Detection Reagent B was then removed andwells were washed five times with 300 μL of 1× Wash Buffer. Followingaspiration of all the Wash Buffer, 904 of Substrate Solution was addedto each well and then incubated at 37° C. for 10-20 min. When a suitablecolour change was achieved, 504 of Stop Solution was added. Theabsorbance was then immediately read at 450 nm (Omega, BMG LabTech Ltd).A standard curve was generated by plotting the mean absorbance, ofduplicate standard wells, against known standard concentrations, andgenerating a line of best fit. Serum sample FKBP-L concentrations werethen calculated.

The % Coefficient of Variation (% CV) was calculated to ensure therewere no large variances between duplicate wells. Serum samples with a CVgreater than 20% were excluded from the study.

FIG. 14 demonstrates that FKBP-L are also associated with an obesephenotype. Lean children had a serum FKBP-L concentration of 1.423ng/mL±0.1694. Obese children had a significantly lower serum FKBP-Lconcentration than lean children (0.9239 ng/mL±0.1078).

FIG. 15 shows that FKBP-L levels also significantly correlate with BMI Zscore in these children; with FKBP-L levels falling as BMI Z scoresincrease. Obese children with a BMI Z Score, in the range 2.0-2.49, havea significantly lower serum FKBP-L concentration than lean children(0.6633 ng/mL±0.1482 and 1.423 ng/mL±0.1694, respectively), It isproposed that FKBP-L could be used as a predictive biomarker forpredisposition to obesity or to identify individuals who might benefitfrom treatment with FKBP-L-based therapy.

Although the invention has been particularly shown and described withreference to particular examples, it will be understood by those skilledin the art that various changes in the form and details may be madetherein without departing from the scope of the present invention.

1. A FKBP-L polypeptide, a biologically active fragment of an FKBP-Lpolypeptide, a derivative of FKBP-L polypeptide, or a derivative of abiologically active fragment of an FKBP-L polypeptide, or a nucleic acidsequence capable of being expressed in a subject to provide FKBP-L or abiologically active fragment or derivative thereof for use in treatingobesity or obesity-related disorders.
 2. A FKBP-L polypeptide, abiologically active fragment of an FKBP-L polypeptide, a derivative ofFKBP-L polypeptide, or a derivative of a biologically active fragment ofan FKBP-L polypeptide, or a nucleic acid sequence capable of beingexpressed in a subject to provide FKBP-L or a biologically activefragment or derivative thereof for use in treating obesity andobesity-related disorders according to claim 1, wherein the FKBP-Lpolypeptide comprises the amino acid sequence shown in SEQ ID NO: 2, orSEQ ID NO:
 29. 3. A FKBP-L polypeptide, a biologically active fragmentof an FKBP-L polypeptide, a derivative of FKBP-L polypeptide, or aderivative of a biologically active fragment of an FKBP-L polypeptide,or a nucleic acid sequence capable of being expressed in a subject toprovide FKBP-L or a biologically active fragment or derivative thereoffor use in treating obesity and obesity-related disorders according toclaim 1, wherein the biologically active fragment of FKBP-L comprises orconsists of the amino acid sequence shown in any one of SEQ ID NOs: 3 to28.
 4. A FKBP-L polypeptide, a biologically active fragment of an FKBP-Lpolypeptide, a derivative of FKBP-L polypeptide, or a derivative of abiologically active fragment of an FKBP-L polypeptide, or a nucleic acidsequence capable of being expressed in a subject to provide FKBP-L or abiologically active fragment or derivative thereof for use in treatingobesity and obesity-related disorders according to claim 1, wherein thebiologically active fragment of FKBP-L consists of the amino acidsequence NH2-IRQQPRDPPTETLELEVSPDPAS-OH (ALM201) orNH2-QIRQQPRDPPTETLELEVSPDPAS-OH (AD-01).


5. A FKBP-L polypeptide, a biologically active fragment of an FKBP-Lpolypeptide, a derivative of FKBP-L polypeptide, or a derivative of abiologically active fragment of an FKBP-L polypeptide, or a nucleic acidsequence capable of being expressed in a subject to provide FKBP-L or abiologically active fragment or derivative thereof for use in treatingobesity and obesity-related disorders according to claim 1, wherein theobesity-related disorder is type 2 diabetes.
 6. A FKBP-L polypeptide, abiologically active fragment of an FKBP-L polypeptide, a derivative ofFKBP-L polypeptide, or a derivative of a biologically active fragment ofan FKBP-L polypeptide, or a nucleic acid sequence capable of beingexpressed in a subject to provide FKBP-L or a biologically activefragment or derivative thereof for use in treating obesity andobesity-related disorders according to claim 1, wherein the FKBP-Lpolypeptide, biologically active fragment or derivative of a FKBP-Lpolypeptide is provided in combination with at least onepharmacologically active agent(s) that is (are) useful in the treatmentof obesity or obesity-related disorders.
 7. A pharmaceutical formulationfor use in the treatment of obesity or obesity-related disorderscomprising a FKBP-L polypeptide, a biologically active fragment of anFKBP-L polypeptide, a derivative of FKBP-L polypeptide, or a derivativeof a biologically active fragment of an FKBP-L polypeptide, or a nucleicacid sequence capable of being expressed in a subject to provide FKBP-Lor a biologically active fragment or derivative thereof for use intreating obesity and obesity-related disorders and at least onepharmaceutical carrier, wherein a FKBP-L polypeptide, or a biologicallyactive fragment or a derivative thereof is present in an amounteffective for use in the treatment of obesity and obesity-relateddisorders.
 8. A method of treating obesity or an obesity-relateddisorder comprising the step of administering to a subject in needthereof a FKBP-L polypeptide, a biologically active fragment of anFKBP-L polypeptide, a derivative of FKBP-L polypeptide, or a derivativeof a biologically active fragment of an FKBP-L polypeptide, or a nucleicacid sequence capable of being expressed in a subject to provide FKBP-Lor a biologically active fragment or derivative thereof.
 9. The methodof claim 8 wherein the FKBP-L polypeptide comprises the amino acidsequence shown in SEQ ID NO: 2, or SEQ ID NO:
 29. 10. The method ofclaim 8 wherein the FKBP-L polypeptide comprises or consists of theamino acid sequence shown in any one of SEQ ID NOs: 3 to
 28. 11. Themethod of claim 8 wherein the FKBP-L polypeptide consists of the aminoacid sequence NH2-IRQQPRDPPTETLELEVSPDPAS-OH (ALM201) orNH2-QIRQQPRDPPTETLELEVSPDPAS-OH (AD-01).
 12. A FKBP-L polypeptide, abiologically active fragment of an FKBP-L polypeptide, a derivative ofFKBP-L polypeptide, or a derivative of a biologically active fragment ofan FKBP-L polypeptide, or a nucleic acid sequence capable of beingexpressed in a subject to provide FKBP-L or a biologically activefragment or derivative thereof for use in treating obesity andobesity-related disorders according to claim 1, wherein obesity is atleast one condition selected from excessive weight gain, glucoseintolerance, diabetes and metabolic syndrome.
 13. A FKBP-L polypeptide,a biologically active fragment of an FKBP-L polypeptide, a derivative ofFKBP-L polypeptide, or a derivative of a biologically active fragment ofan FKBP-L polypeptide, or a nucleic acid sequence capable of beingexpressed in a subject to provide FKBP-L or a biologically activefragment or derivative thereof for use in treating obesity andobesity-related disorders according to claim 1, wherein the nucleic acidis provided in combination with a RALA peptide.